Investigating the Associations Between Socioeconomic Factors and Unhealthy Days among Adults Using Zero-inflated Negative Binomial Regression

Poor social and economic circumstances affect the health of individuals throughout the life cycle. The purpose of the study was to examine whether state-level and individual-level socioeconomic factors are associated with mentally or physically unhealthy days in the general U.S. population of adults. The Behavioral Risk Factor Surveillance System and the American Community Survey in 2016 were used to examine state-level social determinants of health and the number of self-reported mentally unhealthy days in the last 30 days using Zero-Inflated Negative Binomial (ZINB) regression models. Men, older individuals, minorities, persons with higher educational attainment levels, persons who were employed, persons who were married, or with a partner, and persons with one or zero chronic condition were more likely to report excessive zeros for responses to the mentally, and physically unhealthy days. The negative binomial regression results indicated that higher state-level poverty rates, higher income inequity, lower median income, and higher unemployment rates were related to the higher number of reported mentally, and physically unhealthy days. Persons with higher educational attainment, and who were employed reported lower mentally, and physically unhealthy days. The findings show significant relationships between socioeconomic contexts and general health status. Health planners and policymakers may use the results to allocate resources and guide public policies and programs.