Social deprivation, race, and metabolic syndrome in patients with polycystic ovary syndrome

Context: Social determinants of health (SDoH) are a key contributor to cardiovascular disease (CVD) risk, including metabolic syndrome (MetSyn), as well as racial disparities in that risk. It is unknown if SDoH are associated with MetSyn in women with polycystic ovary syndrome (PCOS), who have a high risk of CVD. Furthermore, it is unclear if SDoH contributes to the Black-White disparity in MetSyn among women with PCOS. Objective: To assess the association between the Social Deprivation Index (SDI; a proxy for SDoH) and the development of new-onset MetSyn in women with PCOS and whether SDI plays a role in the racial disparity in MetSyn. Design: Longitudinal cohort study. Setting: Tertiary care center. Patients or Other Participants: Women with hyperandrogenic PCOS and 2+ assessments for MetSyn 3 years apart. Interventions: None. Main Outcome Measures: Development of new-onset MetSyn; proportion of association between race and MetSyn attributable to SDI. Results: Two hundred twenty-two participants were followed for a median of 7 years; 43.7% developed new-onset MetSyn. High SDI, indicating greater social deprivation, was associated with an increased risk of developing MetSyn (adjusted relative risk 1.42, 95% confidence interval 1.07-1.91 adjusting for age), as was Black race. The proportion of the association between race and new-onset MetSyn explained by SDI was 21%. Conclusion: High social deprivation is associated with increased risk of new-onset MetSyn and may contribute to the higher risk in Black compared to White women with PCOS. These results highlight the importance of considering SDoH, particularly in an already high-risk population.