Cumulative effects of adverse social determinants of health on asthma risk: evidence from NHANES

BACKGROUND: Asthma is a chronic inflammatory disease with substantial global public health impact. Emerging evidence suggests that social determinants of health (SDoH) influence asthma risk, yet the cumulative effect of multiple adverse SDoHs remains underexplored. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018, we investigated the association between five specific adverse SDoHs-unemployment, food insecurity, non-private health insurance, renting or non-ownership housing, and being unmarried or not living with a partner-and asthma risk. A cumulative SDoH score was created by summing these five factors, and logistic regression models were used to assess their association with asthma prevalence, adjusting for demographic and clinical factors. RESULTS: Among the 31,075 participants, 14.55% reported having asthma. After adjusting for age, sex, and race, unemployment (AOR = 1.38, 95% CI: 1.24-1.54), food insecurity (AOR = 1.36, 95% CI: 1.24-1.49), non-private insurance (AOR = 1.12, 95% CI: 1.01-1.24), renting (AOR = 1.12, 95% CI: 1.03-1.23), and being unmarried or not living with a partner (AOR = 1.20, 95% CI: 1.10-1.31) were independently associated with higher odds of asthma. The cumulative SDoH score showed a clear dose-response relationship, with higher scores indicating significantly increased odds of asthma (AOR for 5 adverse SDoHs = 2.82, 95% CI: 2.31-3.42). CONCLUSION: Multiple adverse SDoHs are cumulatively associated with increased asthma risk. These findings underscore the need to integrate social context into asthma prevention and management, particularly for socially vulnerable populations.