The association between three key social determinants of health and life dissatisfaction: A 2017 behavioral risk factor surveillance system analysis

Abstract

Poor health outcomes disproportionately impact certain populations in the United States owing to the inequitable distribution of social determinants of health (SDOH). Using the 2017 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the association of three adverse SDOH (housing insecurity, food insecurity, and financial instability) with life dissatisfaction. Participants were from Wisconsin, Minnesota, and Ohio, the only states that included the SDOH and Emotional Support and Life Satisfaction modules (n = 25,850). Six percent of respondents reported life dissatisfaction. Those who reported housing insecurity (Prevalence difference (PD) = 14.2 per 100, 95% CI [7.6, 20.7]), food insecurity (PD = 10.9 [7.1, 14.7]), and financial instability (PD = 5.6 [4.9, 6.3]) had higher prevalence of life dissatisfaction. The differences in prevalence of life dissatisfaction, comparing those with and without an adverse SDOH, decreased with increased emotional support (for housing insecurity, food insecurity, and financial instability, respectively: low support, PD = 30.2 [11.6, 48.8], 22.1 [11.6, 32.6], 16.4 [12.0, 20.8]; high support, PD = 4.8 [−2.9, 12.6], 4.8 [0.0, 9.7], 1.7 [1.1, 2.3]). Participants with frequent mental distress (FMD) had greater prevalence differences than those without FMD (for housing insecurity, food insecurity, and financial instability, respectively: with FMD, PD = 15.4 [7.5, 23.3], 10.7 [4.7, 16.7], 14.4 [9.6, 19.3]; without FMD, PD = 6.1 [−0.5, 12.5], 5.3 [1.6, 9.0], 2.5 [2.0, 3.0]). Social determinants may not only influence physical health but also have an impact on psychological well-being. This impact may be altered by levels of emotional support and FMD.