Association of Social and Behavioral Risk Factors With Earlier Onset of Adult Hypertension and Diabetes

By: Don Gerdts (don.gerdts@3aimstrategy.com), August 8, 2022

SUMMARY

A study titled, “Association of Social and Behavioral Risk Factors With Earlier Onset of Adult Hypertension and Diabetes” published in JAMA Network Open (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733431) found cumulative social (e.g., educational level) and behavioral (e.g., infrequent exercise) risk was significantly associated with earlier onset of hypertension and diabetes. Those with three or more risk factors had the largest increased risk of developing hypertension and diabetes.

The exposures evaluated included race/ethnicity, educational level, financial worry, partnership status, stress, intimate partner violence, concentrated neighborhood poverty, depressive symptoms, infrequent exercise, smoking, heavy alcohol consumption, and cumulative social and behavioral risk.

1. Controlling for age, sex, race/ethnicity, body mass index, and survey year, people with 3 or more risk factors were 41% more likely to develop hypertension compared with those with 0 risk factors.
2. Controlling for age, sex, race/ethnicity, body mass index, and survey year, people with 3 or more risk factors were 53% more likely to develop hypertension compared with those with 0 risk factors.

On the surface, one might initially conclude that these linkages are obvious and logical based on an assumption that the evaluated behaviors, like infrequent exercise, smoking, and heavy alcohol consumption are more directly linked the adverse outcomes than social exposures.

However, this study finds that the opposite is true.  Here are the individual determinants of hypertension and diabetes in rank order of increased hazard ratio:

Hypertension

1. 84% – Having less than a high school educational level.
2. 38% – Being widowed
3. 35% – Smoking
4. 26% – Concentrated neighborhood poverty
5. 22% – Infrequent exercise

Diabetes

1. 68% – Intimate partner violence.
2. 58% – Having less than a high school educational level.
3. 31% – Concentrated neighborhood poverty
4. 53% – Smoking
5. 29% – Financial worry
6. 28% – Depressive symptoms
7. 28% – High Stress

KEY FINDING

Based on this study, education level is a far more prevalent determinant to both hypertension and diabetes than unhealthy behaviors such as smoking and infrequent exercise.

While these risk factors do not stand alone, and other, seemingly important factors such as dietary habits and access to healthy food were not considered, the study identifies the significant role of social exposures in determining the onset of hypertension and diabetes.

CONCLUSION

I’ll continue to highlight the linkages I can find to help inform our planning, development and allocation of resources in the healthcare ecosystem to advance as much as possible in pursuit of the Triple Aim in healthcare.

As we continue to identify these linkages, the main question that I struggle with is this:  As a society, how do we appropriately intervene to address social determinants of health without medicalizing them?

TripleAim Strategy Advisors can help stakeholders in the healthcare ecosystem as a consultant or advisor to identify the most prevalent social determinants of health linked to health outcomes and develop strategies to address them in pursuit of improving equitable, value-based care.

Contact us to discuss this important topic or see additional ways we can help!