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Associations of Race, SDoH, and Polygenic Risk With CHD
Quick Takes
- The SDoHCHD score was highest in self-reported Black and Hispanic people.
- Self-reporting as Blacks had higher odds of having CHD than Whites but not after adjustment for SDoHCHD.
- A 1-SD increase in SDoHCHD and PRSCHD was associated with CHD in models that adjusted for clinical risk factors.
- SDoHCHD and PRSCHD were associated with incident CHD events.
Study Questions:
What is the association between self-reported race/ethnicity, social determinants of health (SDoH), and coronary heart disease (CHD)?
Methods:
Data from the All of Us Study were used for the present study. Participants with available SDoH and whole-genome sequencing data were included. Race/ethnicity was self-reported. SDoH included 22 measures across five domains (food insecurity, income, educational attainment, health literacy, neighborhood disorder, and loneliness). An SDoH score was developed for CHD (SDoHCHD), as was a polygenic risk score (PRSCHD). To investigate the association between multiple SDoH and CHD, a composite SDoH score for CHD (SDoHCHD) was created, and participants were randomized into two cohorts for training and testing. SDoHCHD was a weighted sum of the SDoH measures, with higher SDoHCHD values indicating a higher CHD-associated SDoH burden. The primary outcome of interest was CHD, which was collected from electronic health record data via diagnosis and procedure codes. CHD was defined as present if one or more CHD codes were present.
Results:
Of 245,394 participants with available whole-genome sequence data in version 7 of the All of Us Research Program, 67,256 (65.1% female, mean age 59 ± 16 years) responded to the SDoH survey between November 1, 2021, and June 30, 2022. A total of 77.8% self-reported as White, 7.9% as Black, and 9% as Hispanic, and 2,735 (4.1%) had CHD. SDoH measures across the five domains, including food insecurity, income, educational attainment, health literacy, neighborhood disorder, and loneliness, were associated with CHD. The SDoHCHD score was highest in self-reported Black and Hispanic people. Self-reporting as Blacks had higher odds of having CHD than Whites but not after adjustment for SDoHCHD. SDoHCHD and PRSCHD were weakly correlated. In the test set (n = 33,628), 1-standard deviation (SD) increases in SDoHCHD and PRSCHD were associated with CHD in models that adjusted for clinical risk factors (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23-1.41 and OR, 1.36; 95% CI, 1.28-1.44, respectively). SDoHCHD and PRSCHD were associated with incident CHD events (n = 52) over a median follow-up of 214 days (Q1-Q3, 88 days).
Conclusions:
The authors conclude that increased odds of CHD in people who self-report as Black are likely due to a higher SDoH burden. SDoH and PRS were independently associated with CHD. These findings suggest that including both PRS and SDoH in CHD risk models could improve their accuracy.
Perspective:
The investigators found that PRS and SDoH were only weakly correlated, and that SDoH was not only highest among Black and Hispanic participants but also was associated with CHD. Black participants no longer had higher odds for CHD (compared to White participants) after adjustment for SDoHCHD. These data support the importance of SDoH and the continued need to address modifiable SDoH factors to improve heart health.
Clinical Topics: Prevention
Keywords: Coronary Disease, Race Factors, Risk Assessment, Social Determinants of Health
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