000145550 001__ 145550
000145550 005__ 20250923084435.0
000145550 0247_ $$2doi$$a10.7189/jogh.14.04229
000145550 0248_ $$2sideral$$a140379
000145550 037__ $$aART-2024-140379
000145550 041__ $$aeng
000145550 100__ $$aMoreno-Juste, Aida
000145550 245__ $$aIntersectional analysis of social determinants of health and their association with mortality in patients with multimorbidity
000145550 260__ $$c2024
000145550 5060_ $$aAccess copy available to the general public$$fUnrestricted
000145550 5203_ $$aBackground
We aimed to analyse the association between social determinants of health (SDH) and mortality in patients with multimorbidity from an intersectional point of view.
Methods
We conducted a retrospective observational study in the EpiChron cohort (Aragon, Spain), including all patients with two or more chronic conditions in 2015, who were followed up until 2020, to analyse all-cause mortality. Logistic regressions models were performed to analyse the likelihood of mortality across 24 intersectional strata defined by gender, migration status/length of stay, residence area and socioeconomic class. The area under the receiver operator characteristics curve was estimated to evaluate the discriminatory accuracy of mortality.
Results
Nearly one in 10 people with multimorbidity died during the study period. The likelihood of mortality was higher in men, in people with lower annual gross income, and in those living in rural areas. The intersectional analysis showed that low-income migrant men with more than 15 years in Spain and living in rural settings had a 4.2 times higher risk of death than that observed in middle-high income, non-migrant, urban women (reference group). Women had a lower risk of mortality than men regardless of annual gross income, migration status and residence area. Migrants’ mortality risk varied depending on socioeconomic situation. All models had a large discriminatory accuracy, which increased across the intersectional analysis.
Conclusions
There is a clear association between SDH and mortality in patients with multimorbidity. The intersectional approach used in this study revealed some interactions among these determinants, illustrating the social disadvantage that underlies the need to implement policies to promote equitable health promotion.
000145550 536__ $$9info:eu-repo/grantAgreement/ES/DGA-FEDER/B01-23R$$9info:eu-repo/grantAgreement/ES/ISCIII/PI22-00701$$9info:eu-repo/grantAgreement/ES/ISCIII/PI22-00768$$9info:eu-repo/grantAgreement/ES/ISCIII/PI22-01651$$9info:eu-repo/grantAgreement/ES/ISCIII/PI22-01665$$9info:eu-repo/grantAgreement/ES/ISCIII-RICAPPS/RD21-0016-0019
000145550 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000145550 590__ $$a4.3$$b2024
000145550 592__ $$a1.172$$b2024
000145550 591__ $$aPUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH$$b47 / 419 = 0.112$$c2024$$dQ1$$eT1
000145550 593__ $$aPublic Health, Environmental and Occupational Health$$c2024$$dQ1
000145550 591__ $$aPUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH$$b47 / 419 = 0.112$$c2024$$dQ1$$eT1
000145550 593__ $$aHealth Policy$$c2024$$dQ1
000145550 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000145550 700__ $$aLaguna-Berna, Clara
000145550 700__ $$aPoblador-Plou, Beatriz
000145550 700__ $$aCalderón-Larrañaga, Amaia
000145550 700__ $$aLibrero, Julián
000145550 700__ $$aLozano-Hernández, Cristina
000145550 700__ $$aSantos-Mejías, Alejandro
000145550 700__ $$aCastillo-Jimena, Marcos
000145550 700__ $$aGimeno-Miguel, Antonio
000145550 700__ $$0(orcid)0000-0003-2928-6623$$aGimeno-Feliú, Luis A$$uUniversidad de Zaragoza
000145550 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000145550 773__ $$g14 (2024), 4229 [9 pp.]$$pJournal of global health.$$tJournal of Global Health$$x2047-2978
000145550 8564_ $$s701423$$uhttps://zaguan.unizar.es/record/145550/files/texto_completo.pdf$$yVersión publicada
000145550 8564_ $$s2772631$$uhttps://zaguan.unizar.es/record/145550/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000145550 909CO $$ooai:zaguan.unizar.es:145550$$particulos$$pdriver
000145550 951__ $$a2025-09-22-14:46:26
000145550 980__ $$aARTICLE