Social determinants of health and aging outcomes in people aging with disability: Findings from the health and retirement study 2006-2020.

BACKGROUND: Social determinants of health (SDOH) significantly contribute to health outcomes and the aging process. Although substantial research has investigated the associations between SDOH and aging in the general population, their associations with aging-related outcomes among people aging with disability remain understudied.

OBJECTIVE: To examine the associations between SDOH and two dimensions of aging, phenotypic and functional.

METHODS: An observational study was conducted using data from the 2006-2020 waves of the Health and Retirement Study. People aging with disability were defined as individuals who reported impairments that began before age 45 and persisted for at least five years. SDOH were categorized based on the Healthy People 2030 framework. Phenotypic aging was measured by metabolic dysfunction risk score, and functional aging was measured by limitations in activities of daily living and instrumental activities of daily living. Hierarchical linear mixed models and Poisson generalized linear mixed-effects models were employed.

RESULTS: A total of 1,872 individuals were included. Race/ethnicity and health insurance status were significantly associated with both phenotypic and functional aging. Higher educational attainment and active social participation were protective, whereas experiences of food insecurity and discrimination were associated with poorer aging outcomes.

CONCLUSIONS: Interventions addressing SDOH, particularly those that enhance social integration and reduce experience of discrimination, may help promote more equitable aging-related health outcomes in this population. These findings provide actionable insights for the development of disability-inclusive aging policies and programs.