Associations of Social and Behavioral Determinants of Health Index with Self-Rated Health, Functional Limitations, and Health Services Use in Older Adults

Taeho Greg Rhee, Richard A Marottoli, Leo M Cooney, Richard H Fortinsky

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


OBJECTIVES: To characterize the cumulative risk factors of social and behavioral determinants of health (SDoH) and examine their association with self-rated general health, functional limitations, and use of health services among US older adults. DESIGN: Cross-sectional analysis of the 2013-2014 National Health and Nutrition Examination Survey. SETTING: Nationally representative health interview survey in the United States. PARTICIPANTS: Survey respondents aged 65 or older (n = 1,306 unweighted). MEASUREMENTS: A cumulative risk score of SDoH, developed by the National Academy of Medicine expert panel, was assessed using validated measures. Outcome variables included self-rated general health, functional limitations (eg, activities of daily living), and use of health services (eg, usual source of care and overnight hospitalization). We quantified the cumulative risk score of SDoH in older adults and used multivariable-adjusted logistic and Poisson regression analyses to assess the association of SDoH with self-rated health, functional limitations, and use of health services, adjusting for other covariates. RESULTS: About 25.7% of older adults, representative of 11.0 million people nationwide, reported having three or more cumulative SDoH risk factors. These older adults were more likely to have functional limitations (eg, activities of daily living) and less likely to report their general health as “very good” or “excellent” than those with two or fewer cumulative SDoH risk factors (P <.001 for each). Each additional cumulative SDoH risk factor was associated with increased odds of not having a usual source of care (adjusted odds ratio = 1.57; 95% confidence interval = 1.09-2.27). CONCLUSION: The SDoH index score may be a useful tool to predict access to care and quality of care in older adults. J Am Geriatr Soc 68:1731-1738, 2020.

Original languageEnglish (US)
Pages (from-to)1731-1738
Number of pages8
JournalJournal of the American Geriatrics Society
Issue number8
Early online dateMar 30 2020
StatePublished - Aug 2020

Bibliographical note

Funding Information:
In the past 3 years, Taeho Greg Rhee was supported in part by the National Institute on Aging (grant T32AG019134) through Yale University School of Medicine. The authors have declared no conflicts of interest for this article. Study concept and design: Rhee. Data acquisition and statistical analyses: Rhee. Interpretation of data: All authors. Drafting of manuscript: Rhee. Critical revision of manuscript for important intellectual content: All authors. The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.

Publisher Copyright:
© 2020 The American Geriatrics Society


  • functional limitations
  • health services use
  • older adults
  • self-rated health
  • social determinants of health

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'Associations of Social and Behavioral Determinants of Health Index with Self-Rated Health, Functional Limitations, and Health Services Use in Older Adults'. Together they form a unique fingerprint.

Cite this