Creation and validation of a polysocial score for mortality among community-dwelling older adults in the USA: the health and retirement study

Abstract

Background the interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person- centred social interventions. Methods participants ([n = 7,383], 54.5% female) were aged 65 years or above who complete an additional psychosocial questionnaire in the health and retirement study in 2006 or 2008. Social determinants of health encompassed five social domains: economic stability, neighbourhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 5-year mortality. Indices of goodness-of-fit, discrimination and reclassification were used to assess model performance. We used logistic regression to identify the association between polysocial score and mortality. Subgroup analyses were conducted to examine sex- and race-specific association. Results polysocial score was created using 14 social determinants of health. In the training cohort, the C-statistic was 0.71 for the reference model (only age, sex and race/ethnicity) and increased to 0.75 for the continuous and categorical polysocial score. Compared with the reference model, the integrated discrimination index for adding the continuous or categorical polysocial score was both 0.03 (P values < 0.001). Participants with an intermediate (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.51–0.82) or high (OR = 0.48; 95% CI, 0.38–0.60) polysocial score had lower odds of death than those in the low category in the fully adjusted model, respectively. Conclusions the polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.

Association of Joint Genetic and Social Environmental Risks With Incident Myocardial Infarction: Results From the Health and Retirement Study

“…We assessed the association of social environmental risk with MI using the polysocial score, which included neighborhood social cohesion, household income, education, and stress. Using a developed polysocial score, 17 we not only found the association of a disadvantaged social environment with a high risk of incident MI in the intermediate and high genetic risk categories but also found the joint effect of intermediate/high genetic risk and high social environmental risk in the development of incident MI.…”

“…Guided by our previous work, 17 we used a polysocial score developed based on 14 social determinants from the following 5 domains: (1) economic stability, (2) neighborhood and physical environment, (3) education, (4) community and social contexts, and (5) health care system (Table S1 ). This polysocial score was developed among 7383 adults aged ≥65 years and was shown to be predictive of all‐cause mortality.…”

“…This polysocial score was developed among 7383 adults aged ≥65 years and was shown to be predictive of all‐cause mortality. 17 …”

“… 20 We assessed social engagement and stress (life‐threatening illness, natural disasters, addiction, unemployment, and crime) per the guidelines of the previous study. 17 …”

“…Motivated by the polygenic risk score, 16 we developed a polysocial score to capture the aggregate health effects of a wide range of social factors among US older adults. 17 This novel tool provides an opportunity to examine how the social environment influences the risk of MI across different levels of genetic susceptibility and whether the social environment could attenuate the genetic risk.…”