Cumulative social determinants of health and reproductive lifespan among US women: a NHANES 1999-2018 analysis

OBJECTIVES: To investigate the associations of individual and cumulative social determinants of health (SDoH) with reproductive lifespan among US women using nationally representative National Health and Nutrition Examination Survey (NHANES) data. METHODS: This cross-sectional study used data from the NHANES 1999-2018. A total of 8,576 women aged ≥45 years were included. Reproductive lifespan was defined as the interval between age at menarche and menopause. SDoH indicators included socioeconomic status, education, marital status, employment, food security, health care access, insurance, and housing. Weighted linear regression models were used to examine associations between individual SDoH indicators and reproductive lifespan. Weighted quantile sum regression was applied to assess the joint effects of multiple SDoH factors. RESULTS: In weighted linear regression analyses, lower education level, lower poverty income ratio (PIR), and renting a home were significantly associated with a shorter reproductive lifespan. Weighted quantile sum analysis further showed that higher cumulative social disadvantage was significantly associated with a shorter reproductive lifespan (β=-3.06, 95% CI: -3.92 to -2.19, P<0.001). Food security contributed the highest weight to the mixture (0.34), followed by housing status (0.25), education level (0.17), and PIR (0.16). Sensitivity analyses supported the main findings. CONCLUSIONS: Higher cumulative social disadvantage was associated with a shorter reproductive lifespan among women. Food security, housing status, education level, and PIR were important contributors within the SDoH mixture, highlighting the potential relevance of SDoH in reproductive aging.