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Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis

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Abstract

Background

Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status.

Method

This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status.

Results

The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk.

Conclusions and relevance

Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations.

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Data availability

The data are available from the corresponding authors on a reasonable request.

Code availability

Not applicable.

Abbreviations

AIC:

Akaike information criteria

ANOVA:

Analysis of variance

BIC:

Bayesian information criterion

BLRT:

Bootstrapped likelihood ratio test

CI:

Confidence intervals

HADS:

Hospital Anxiety and Depression Scale

HBI-SF:

Health Behavior Inventory–Short Form

LPA:

Latent profile analysis

OR:

Odds ratios

PPPM/3PM:

Predictive, preventive, and personalized medicine

QR:

Quick response

SABIC:

Sample-adjusted Bayesian information criteria

SD:

Standard deviation

SDH:

Social determinants of health

SHSQ-25:

Suboptimal Health Status Questionnaire

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

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Funding

This work was supported by the Macao Foundation (Grant number 0828/DGAF/2023–03).

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Authors and Affiliations

  1. Research Management and Development Department, Kiang Wu Nursing College of Macau, Macao, China

    Lai Kun Tong

  2. Education Department, Kiang Wu Nursing College of Macau, Macao, China

    Yue Yi Li & Mio Leng Au

  3. School of Nursing, Yangzhou University, Yangzhou, China

    Yong Bing Liu

  4. Faculty of Health Sciences, University of Macau, Macao, China

    Mu Rui Zheng

  5. Infectious Disease Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Guang Lei Fu

  6. Avenida Do Hospital, Complexo de Cuidados de Saúde das Ilhas – Edifício do Instituto de Enfermagem Kiang Wu de Macau, das Ilhas No.447, Coloane, RAEM, Macao, China

    Mio Leng Au

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Concept and design: all authors. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: Tong. Critical review of the manuscript for important intellectual content: all authors. Statistical analysis: Tong. Obtained funding: Tong. Administrative, technical, or material support: Tong, Au. Supervision: Tong, Au. All authors reviewed the manuscript.

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Correspondence to Mio Leng Au.

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The study received ethical approval from the Research Management and Development Department of Kiang Wu Nursing College of Macau (No. REC-2022.1102).

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All procedures performed in the study involving human participants were in accordance with the principles outlined in the Helsinki Declaration. The participants read and agreed to the informed consent before starting to fill in the questionnaire. In order to assure voluntariness, participants could withdraw at any time without losing benefits.

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All authors reported receiving grants from the Macao Foundation during the conduct of the study. No other disclosures were reported.

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Tong, L.K., Li, Y.Y., Liu, Y.B. et al. Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis. EPMA Journal (2024). https://doi.org/10.1007/s13167-024-00365-5

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