ORIGINAL RESEARCH article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Low Education and Employment Status Drive Cardiometabolic Health: A Social Determinants Perspective in Chinese Population
Provisionally accepted
- 1Shanghai Changzheng Hospital, Huangpu, China
- 2Shanghai Changzheng Hospital, Shanghai, China
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Background: Cardiovascular-kidney-metabolic (CKM) syndrome has emerged a major strain on healthcare systems worldwide, with marked disparities in incidence across different regions, which are partly attributed to social determinants of health (SDOH). While research has touched upon the link between SDOH and CKM, and isolated SDOH factor's influence on cardiovascular health has been probed in China, evaluation of how SDOH collectively affect CKM in Chinese population remains underexplored in a systematic fashion. Methods: The study drew on Shanghai community population (STONE cohort, n = 4,066) recruited via a three-phase stratified sampling scheme. Standardised interviews captured education, marital status, employment, household income, and neighbourhood characteristics as SDOH exposures. CKM stages 0–4 were assigned using American Heart Association (AHA) criteria. Multinomial logistic regression quantified SDOH–CKM relationships, with age-, sex-, and lifestyle-stratified analyses to pinpoint vulnerable subgroups. Results: Unfavourable SDOH profiles, including limited schooling (OR = 8.18; 95% CI: 6.16–10.86), unemployment or retirement (OR = 11.38; 95% CI: 8.59–15.08), and low income (OR = 2.24; 95% CI: 1.78–2.81) were robustly linked to CKM advancement independent of classic metabolic risk factors. The effect was present only among adults aged 36–50 years (OR = 2.45; 95% CI: 1.37–4.40). Women clear of alcohol displayed elevated odds with advanced CKM stages, whereas men did not show significant association with CKM progression. Conclusions: Unfavorable SDOH, especially low education and unemployed or retired, and limited income, constitute independent determinants of CKM progression. Embedding SDOH metrics into routine CKM surveillance and designing targeted interventions for mid-life adults and women could transform primary prevention strategies.
Keywords: Cardiovascular-kidney-metabolic (CKM) syndrome, Education, Employment, Income, social determinants of health (SDOH)
Received: 02 Aug 2025; Accepted: 26 Nov 2025.
Copyright: © 2025 Li, Zhang, Cai, Tang, Song, Zhang and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tuo Li
Yong-Quan Shi
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