| Title: | Social determinants of health and female reproductive health: risk score development and cross-national study based on multi-national analysis |
| Journal: | Journal of Advanced Research |
| Published: | 19 Mar 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41864612/ |
| DOI: | https://doi.org/10.1016/j.jare.2026.03.038 |
| URL: | http://dx.doi.org/10.1016/j.jare.2026.03.038 |
Publication 17338
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Abstract
INTRODUCTION: Social determinants of health (SDoH) significantly influence female reproductive health. However, existing research has predominantly focused on examining the impact of SDoH on individual reproductive health indicators, lacking comprehensive assessments of their cumulative effects on overall reproductive health and systematic evaluations of multidimensional SDoH exposures. Investigating the influence of SDoH on reproductive health under conditions of cross-national comparability holds critical public health significance for advancing health equity goals.</p>
OBJECTIVES: To explore the association between multidimensional SDoH scores and the composite reproductive health index (RRS) and to identify potential causal mechanisms. Additionally, to assess whether the impact of SDoH on reproductive health varies based on individual behavioral characteristics and/or metabolic health status.</p>
METHODS: This cross-sectional study analyzed data from the UK Biobank (UKB, n = 12,512) and the US National Health and Nutrition Examination Survey (NHANES, n = 2,834). Weighted and unweighted SDoH scores were constructed based on the five core domains outlined in Healthy People 2030. The reproductive risk score (RRS) was derived from 17 (UKB) and 12 (NHANES) reproductive health variables, respectively. Multivariable linear regression models were employed to assess the association between SDoH and RRS, supplemented by subgroup and interaction analyses. Additionally, two-sample Mendelian randomization (MR) was performed using genome-wide association study (GWAS) summary statistics to evaluate potential causal relationships between educational attainment and 13 RRS-related variables.</p>
RESULTS: Higher SDoH scores (indicating greater disadvantage) were linearly associated with increased RRS in both cohorts (UKB: Unweighted SDoH score: β = 0.048, 95% CI = 0.037, 0.059, P < 0.001; Weighted SDoH score: β = 0.100, 95% CI = 0.084, 0.117, P < 0.001.</p>
NHANES: Unweighted SDoH score: β = 0.118, 95% CI = 0.065, 0.171, P < 0.001; Weighted SDoH score: β = 0.129, 95% CI = 0.078, 0.180, P < 0.001). Compared with the favorable SDoH group, the unfavorable SDoH group exhibited significantly higher RRS in the UKB population (Unweighted: β = 0.237, 95% CI = 0.172, 0.302, P < 0.001; Weighted: β = 0.309, 95% CI = 0.243, 0.375, P < 0.001). In the NHANES population, both the medium SDoH group (Unweighted: β = 0.409, 95% CI = 0.095, 0.723, P = 0.011; Weighted: β = 0.378, 95% CI = 0.082, 0.674, P = 0.013) and the unfavorable SDoH group (Unweighted: β = 0.432, 95% CI = 0.118, 0.747, P = 0.008; Weighted: β = 0.613, 95% CI = 0.278, 0.947, P < 0.001) demonstrated significantly elevated RRS. Subgroup analyses revealed effect modification by age, BMI, diabetes status, smoking, and physical activity. Mendelian randomization (MR) analysis identified significant causal associations between educational attainment and six RRS-related variables, an inverse association with one variable, and no significant associations with six variables.</p>
CONCLUSION: This study provides the first systematic evidence of a positive dose-response relationship between SDoH scores and female reproductive risk. The findings highlight complex, multi-pathway mechanisms through which SDoH influences reproductive health, modulated by behavioral and metabolic factors. These results underscore the importance of targeted socioeconomic interventions-including improved educational opportunities, economic support, and social environment enhancements-to mitigate disparities in women's reproductive health outcomes.</p>
12 Authors
- Yu Guan
- Wenzhu Li
- Feng Zhang
- Sirui Liu
- Weiqian Zhang
- Jia Liang
- Ruhui Zhan
- Juan He
- Tailang Yin
- Jue Liu
- Dongdong Tang
- Yan Zhang
1 Application
| Application ID | Title |
|---|---|
| 280100 | The Influence of Genetic and Environmental Factors on Reproductive and Sexual Health |
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