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How do social determinants of health affect chronic disease?

Understanding how social determinants of health affect chronic disease will be key to the nation's current discourse on chronic disease prevention and management.

Sara Heath
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Published: 30 May 2025

The nation's healthcare system is again laser-focused on chronic disease, with stakeholders prioritizing efforts targeting both prevention and management. In order to achieve better chronic care, it is important to understand the role social determinants of health play in chronic disease.

Defined by the Centers for Disease Control and Prevention (CDC) as the non-medical factors that affect health outcomes, social determinants of health (SDOH) weigh heavily on chronic illness. Indeed, studies have shown that up to 50% of health is defined by SDOH and socioeconomic factors.

That means people who experience more SDOH tend to be the most likely to also have a chronic illness.

One 2022 study in the journal Preventive Medicine showed that people with three or more SDOH were 3.9 times more likely to score high on a depression risk screening. Those with transportation barriers were 84% more likely to have an alcohol or drug use disorder and 41% more likely to smoke. Meanwhile, those with a housing quality issue were 37% more likely to have asthma.

In a separate 2024 CDC study, researchers found that the more chronic illnesses an individual reported, the more SDOH they reported.

SDOH can greatly affect whether or how someone engages in their health and well-being. Whether it's increasing their risk for chronic illness, limiting chronic disease prevention or complicating chronic disease management, SDOH are deeply intertwined with disease and must, therefore, be well-understood by experts.

Chronic disease risk

Foremost, SDOH can affect an individual's risk for developing a chronic illness. When patients are exposed to certain elements or health behaviors -- or when SDOH bar them from key resources to keep them healthy -- they are at higher risk for certain chronic diseases.

The list of chronic illnesses caused or driven by SDOH is long, according to a group of researchers from the University of Alabama at Birmingham writing in an American Journal of Preventive Medicine article.

Some of the most common chronic diseases stemming from SDOH include the following:

  • Cardiovascular disease.
  • Type 2 diabetes.
  • Stroke.
  • Cancers.
  • Pulmonary diseases.
  • Kidney disease.

"Importantly, the effect of social determinants is not limited to infectious diseases; it extends to chronic diseases as well," the researchers wrote. "Several studies have found that the social context of a person's life determines the risk of exposure, degree of susceptibility, and the course and outcome of a disease -- regardless of whether it is infectious, genetic, metabolic, malignant, or degenerative. Social factors can initiate the onset of the pathology and in this way serve as a direct cause for a number of chronic diseases."

For example, an individual living in an area with significant air pollution -- which would represent environmental factors as an SDOH -- is at higher risk for developing respiratory illnesses, like asthma, COPD or even lung cancer. Patients in food deserts or food swamps are often more likely to develop diet-related illnesses, like diabetes.

"These variables have direct effects on both unhealthy and healthy lifestyles, high- or low-risk health behavior, and on living conditions, food security, levels of stresses and strains, social disadvantages over the life course, environmental factors that influence biological outcomes through gene expression, and other connections to chronic diseases," the University of Alabama at Birmingham researchers explained.

Chronic disease prevention

Part of why patients experiencing one or more SDOH have an increased risk of developing a chronic illness is that SDOH can make it difficult for individuals to engage in chronic disease prevention.

According to the CDC, chronic disease prevention amounts to maintaining a healthy lifestyle that avoids certain risk factors. Those lifestyle habits can include the following:

  • Not smoking or initiating smoking cessation.
  • Following a nutrient-dense diet.
  • Engaging in regular physical activity.
  • Limiting alcohol consumption.
  • Accessing preventive screenings.
  • Adhering to good oral hygiene.
  • Keeping a well-documented family history.

However, SDOH can get in the way of many of those lifestyle choices. Living in a food desert or swamp, for instance, can make it hard to maintain a healthy diet. People living in places with high neighborhood violence might not be able to engage in regular physical activity outside, while transportation barriers or low income might keep some from accessing regular preventive screenings.

But it's not just that SDOH impose barriers to healthy lifestyle and chronic disease prevention. They can also shape an individual's culture and lifestyle, predisposing them to certain illnesses. Take, for instance, smoking or smoking cessation.

"Social structures can therefore channel health lifestyle choices down specific pathways as opposed to others that could be selected," say the University of Alabama researchers. "People may have options, but generally choose along class lines and in accordance with other structural influences relevant to them."

"Smokers also show a characteristic social pattern that indicates tobacco use is not a random, individual decision completely independent of social influences," the research team continues. "Rather, some people, especially those from socially disadvantaged circumstances, collectively express poor health habits like smoking and have greater exposure to the types of social situations that promote this behavior."

SDOH like low income, debt, stress and unemployment can also limit smoking cessation.

Ultimately, SDOH pose dual risks. Foremost, they can bar individuals from accessing and engaging in certain healthy behaviors that constitute chronic disease prevention. Additionally, they can predispose individuals to engaging in certain poor health habits and make it more difficult to reverse those habits.

Chronic disease management

Being that SDOH can increase chronic disease risk and complicate chronic disease prevention, it is not surprising that folks experiencing multiple health-related social needs shoulder a greater chronic disease burden.

And when individuals do develop a chronic illness, those same SDOH also limit their ability to manage it.

In 2022, researchers found that even having just one health-related social need limited chronic disease management for individuals with hypertension. While those experiencing no SDOH achieved 73% hypertension control during a one-year assessment window, people facing one SDOH achieved only an average 60% hypertension control rate.

When people had two or more SDOH, hypertension control rates fell to 55%.

SDOH limit chronic disease management because they can often limit an individual's ability to access healthcare or access the tools and resources necessary to engage in disease management. Taking the food desert or swamp example from above, folks with limited access to nutritious foods will have more trouble managing a diet-related illness like diabetes.

Folks who are low-income or live in a rural area with poor broadband might struggle to utilize the remote patient monitoring tools that have come to support many chronic care management programs. Low income can also predict poor medication adherence, as cost tends to be the biggest barrier to obtaining and taking medications as prescribed.

What does this mean?

No matter how it's framed, social determinants of health have a significant impact on chronic illness. Whether it's prevention or management, individuals facing one or more health-related social need will struggle with chronic illness regardless of the medical interventions they can access.

Some healthcare organizations are facing this reality by better understanding how SDOH affect their patient populations. SDOH screening during patient intake is important for flagging the specific factors impacting individual patients. Looking at that data at scale and combining it with community health needs assessments can help healthcare organizations tailor their SDOH interventions and community health partnerships.

Indeed, many healthcare organizations and public health stakeholders have had success addressing SDOH in the name of better care access and disease management.

For example, payer- and provider-sponsored non-emergency medical transportation programs have improved access to care and outcomes. When payers and providers can guarantee a ride to the hospital or clinic, it's more likely the patient will go.

Similarly, public programs like SNAP have been effective in mediating racial disparities in food security, some data has shown. Separate studies have also shown that SNAP helps create financial stability and has made it easier for beneficiaries to afford their medications, improving overall medication adherence, which is a key tenet of chronic disease management.

Notably, industry stakeholders need to understand who is able to access key resources that can help prevent and manage disease. Income is one of the most defining social determinants of health because it has an impact on a litany of other social needs. To that end, SDOH interventions need to be affordable to promote health equity and avoid deepening health disparities.

By addressing health-related social needs early on, healthcare organizations can be proactive rather than reactive in chronic disease prevention and management. Taking care of individual social needs plus delivering the clinical and medical interventions necessary to manage illness will be critical as the nation stares down a chronic disease epidemic.

Sara Heath has reported news related to patient engagement and health equity since 2015.

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