Social determinants of health and progression to cardio–renal–metabolic multimorbidity and mortality in people with prediabetes: A prospective cohort study
Authors' conclusion
Unfavourable SDHs were associated with increased risks of progression from prediabetes. Resource allocation and lifestyle promotion should be prioritised for those with unfavourable SDHs to mitigate disparities in progression to CRMM and death in diabetes care, especially in the early disease stage.
Study context
- Population
- Participants with prediabetes, free of cardio-renal-metabolic disease (CRMD) (T2D, CVD, CKD) at baseline, UK Biobank
- Participants
- 37,098 participants
- Exposure
- Unfavourable vs medium vs favourable SDH score
- Outcome
- Transitions from prediabetes to first CRMD, CRMM (≥2 CRMDs) and death (five transition paths)
Methodological detailsmultistate models, mediation analysis
- Multistate models
- Mediation analysis
Main finding
As reported in the abstract
Transition stages from prediabetes to CRMD, CRMM and death
- Unfavourable vs favourable SDH: consistently elevated risks for different transition stages, except cardio-renal-metabolic multimorbidity (CRMM)-to-death transition
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CKD-to-death transitionUnfavourablevs FavourableHighest risk among disease-specific associations | 2.22 (1.16–4.26) | |
| 0.20.5125Hazard ratio (log scale) |
Mediation by lifestyle
- Lifestyle partially mediated the associations; mediation proportion at each stage
- less than 20%
CKD-to-death transition
- Unfavourable SDHs disproportionally increased the risks of three CRMDs
Original publication
Social determinants of health and progression to cardio–renal–metabolic multimorbidity and mortality in people with prediabetes: A prospective cohort study. Diabetes Obes Metab. Published 27 August 2025. doi:10.
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