title: New social adaptability index predicts overall mortality.
abstract: BACKGROUND
  Definitions of underprivileged status based on race, gender and geographic location are neither sensitive nor specific; instead we proposed and validated a composite index of social adaptability (SAI).
  
  
  METHODS
  Index of social adaptability was calculated based on employment, education, income, marital status, and substance abuse, each factor contributing from 0 to 3 points. Index of social adaptability was validated in NHANES-3 by association with all-cause and cause-specific mortality.
  
  
  RESULTS
  Weighted analysis of 19,593 subjects demonstrated mean SAI of 8.29 (95% CI 8.17-8.40). Index of social adaptability was higher in Whites, followed by Mexican-Americans and then the African-American population (ANOVA, p < 0.001). The SAI was higher in subjects living in metropolitan compared to rural areas (T-test, p < 0.001), and was greater in men than in women (T-test, p < 0.001). In Cox models adjusted for age, comorbidity index, BMI, race, sex, geographic location, hemoglobin, serum creatinine, albumin, cholesterol, and glycated hemoglobin levels, SAI was inversely associated with mortality (HR 0.87 per point, 95% CI 0.84-0.90, p < 0.001). This association was confirmed in subgroups.
  
  
  CONCLUSIONS
  We proposed and validated an indicator of social adaptability with a strong association with mortality, which can be used to identify underprivileged populations at risk of death.
authors.affiliation: Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Goldfarb-Rumyantzev
authors.forename: Anna
authors.initials: A
authors.lastname: Barenbaum
authors.forename: James
authors.initials: J
authors.lastname: Rodrigue
authors.forename: Preeti
authors.initials: P
authors.lastname: Rout
authors.forename: Ross
authors.initials: R
authors.lastname: Isaacs
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mukamal