Abstract
Background
Social determinants of health (SDOH) are linked to adverse diabetes outcomes internationally, but it remains unclear whether these associations are uniform or concentrated across major treatment targets in Korea's universal-coverage setting.Methods
We analyzed two Korea National Health and Nutrition Examination Survey cohorts (2021??024, n=3,129; 2011??014, n=2,602). A 4-item SDOH composite was derived from 14 candidate items; because the cohort×SDOH interaction was nonsignificant (P=0.36), the cohorts were pooled (n=5,731). Outcomes included diabetic kidney disease (DKD)-related laboratory abnormalities, defined using Kidney Disease: Improving Global Outcomes (KDIGO)-consistent single-measurement thresholds, severe hyperglycemia (glycosylated hemoglobin [HbA1c] ≥8%), uncontrolled blood pressure (≥140/85 mm Hg), and elevated low-density lipoprotein cholesterol (LDL-C; ≥100 mg/dL). Associations were analyzed using survey-weighted logistic regression adjusted for age, sex, body mass index, and cohort.Results
The composite showed a dose-response association with DKD-related laboratory abnormalities (15.9% [score 0] to 34.2% [score ??]; odds ratio [OR] per +1 item, 1.23; 95% confidence interval [CI], 1.14 to 1.33; PConclusion
Cumulative social disadvantage was associated with DKD-related laboratory abnormalities and severe hyperglycemia, but not failure to meet blood pressure or lipid targets. These exploratory findings may inform future SDOH assessment in Korean diabetes care. Longitudinal registry-linked studies are needed to confirm chronicity and temporality.