Social determinants of health, life expectancy, and future health risks among adults with rheumatoid arthritis: two cohort studies in China and the UK

This study investigated associations between social determinants of health (SDoHs) and life expectancy and health risks among rheumatoid arthritis (RA) patients in China and the UK. Based on data from China Kadoorie Biobank (10 298 patients aged 30-79 years) and UK Biobank (4975 patients aged 37-73 years), composite SDoH scores incorporating 5 domains (financial circumstances, education, healthcare access, neighborhood environment, and social context) were generated based on mortality associations and categorized into favorable, medium, and unfavorable groups. During a median follow-up of 10.4 years (China) and 13.8 years (UK), unfavorable SDoH was associated with higher mortality risk in both cohorts (China: HR, 1.62 [95% CI, 1.36-1.92]; UK: HR, 1.80 [95% CI, 1.50-2.16]). Life expectancy reduction at age 45 due to unfavorable SDoH showed sex-specific patterns within each cohort: in China, women lost 4.7 years and men lost 4 years; in the UK, men lost 6.8 years and women lost 4 years. Phenome-wide analysis for incident diseases identified 51 conditions with 1.2- to 5.2-fold increased risks among those with unfavorable SDoH, including heart failure, obstructive chronic bronchitis, and renal failure. Findings suggest that disadvantaged SDoHs were associated with significantly lower life expectancy and higher risks of multiple adverse health outcomes among adults with RA.