The association between social determinants of health and Parkinson's disease prevalence among U.S. adults: A cross-sectional study.
BACKGROUND Social determinants of health (SDOH) encompass the economic, social, and environmental conditions that shape health outcomes. While SDOH are increasingly recognized as fundamental drivers of chronic disease, their relationship with Parkinson's disease (PD) remains poorly characterized. OBJECTIVE To examine the association between individual and cumulative adverse SDOH and PD prevalence in a nationally representative sample of U.S. adults. METHODS We conducted a cross-sectional analysis of 24,018 adults from the 2003-2016 National Health and Nutrition Examination Survey. A cumulative SDOH score (range 0-8) was constructed from eight adverse conditions across employment, income, food security, education, healthcare access, health insurance, housing stability, and marital status. PD was defined by anti-Parkinsonian medication use. Survey-weighted multivariable logistic regression was used, adjusting for demographic, behavioral, and clinical covariates. RESULTS The weighted prevalence of PD was 0.75%. In fully adjusted models, each one-point increase in the cumulative SDOH score was associated with 21% higher odds of PD (OR 1.21; 95% CI 1.12-1.32). Compared to those with no adverse SDOH, individuals with 4-8 adversities had 2.59-fold higher odds of PD (95% CI 1.52-4.41), with a significant relationship. Unemployment, food insecurity, lack of health insurance, housing instability, and unmarried status demonstrated independent associations with PD. CONCLUSIONS Cumulative social disadvantage is independently associated with PD prevalence in U.S. adults. These findings suggest that social context may represent an underrecognized dimension related to PD and warrant further investigation into mechanisms linking social adversity to neurodegenerative disease.