The social determinants of health-related quality of life among people with chronic disease: a systematic literature review

Purpose This systematic review investigates the relationship between Social Determinants of Health (SDoH) and Health-
Related Quality of Life (HRQoL) among individuals with chronic diseases. SDoH refer to the conditions in which people
live, work, and interact, which are associated with health outcomes and inequalities. Understanding these determinants in the
context of chronic diseases is essential for developing targeted interventions to improve their HRQoL.
Methods We conducted a systematic review following PRISMA guidelines, searching PubMed, Web of Science, and
Embase for original research articles published in English during the last 10 years. Studies included quantitative assessments
of the relationship between SDoH and HRQoL in chronic disease populations. 38 studies met the eligibility criteria and were
included in the analysis.
Results Significant bivariate associations between SDoH and HRQoL were observed. Younger age, male gender, higher
social support, being married, higher education level, employment, higher income, and urban living were generally linked to
better HRQoL. Multivariate analyses identified higher education and income as consistent predictors of better HRQoL when
considered alongside other SDoH. Urbanization, age, and gender showed some mixed associations with HRQoL, highlighting
the need for context-specific interventions.
Conclusion The findings underscore the critical role of SDoH in HRQoL among chronic disease populations. Policies aimed
at improving HRQoL should consider multiple SDoH, particularly focusing on patients with low educational attainment
living in low-income areas. However, variability in sample sizes and HRQoL measures complicate comparison. The predominance
of cross-sectional studies limits the understanding of time-related effects, thus, future research should prioritize
longitudinal studies.