Associations of Self-Reported Race, Social Determinants of Health, and Polygenic Risk With Coronary Heart Disease

Social determinants of health (SDOH) influence the risk of common diseases such as coronary heart disease (CHD). This study sought to test the associations of self-reported race/ethnicity, SDOH, and a polygenic risk score (PRS), with CHD in a large and diverse U.S. In 67,256 All of Us (AoU) particip...

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Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 84; no. 22; p. 2157
Main Authors: Norland, Kristjan, Schaid, Daniel J, Naderian, Mohammadreza, Na, Jie, Kullo, Iftikhar J
Format: Journal Article
Language:English
Published: United States 26.11.2024
Subjects:
Adult
Aged
Cohort Studies
Coronary Disease - epidemiology
Coronary Disease - ethnology
Coronary Disease - genetics
Female
Humans
Male
Middle Aged
Multifactorial Inheritance - genetics
Racial Groups
Risk Assessment - methods
Risk Factors
Self Report
Social Determinants of Health
United States - epidemiology
United States
social determinants of health
coronary heart disease
polygenic risk scores
ISSN:1558-3597, 1558-3597
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Summary:Social determinants of health (SDOH) influence the risk of common diseases such as coronary heart disease (CHD). This study sought to test the associations of self-reported race/ethnicity, SDOH, and a polygenic risk score (PRS), with CHD in a large and diverse U.S. In 67,256 All of Us (AoU) participants with available SDOH and whole-genome sequencing data, we ascertained self-reported race/ethnicity and 22 SDOH measures across 5 SDOH domains, and we calculated a PRS for CHD (PRS , PGS004696). We developed an SDOH score for CHD (SDOH ). We tested the associations of SDOH and PRS with CHD in regression models that included clinical risk factors. SDOH across 5 domains, including food insecurity, income, educational attainment, health literacy, neighborhood disorder, and loneliness, were associated with CHD. SDOH 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 SDOH . SDOH and PRS were weakly correlated. In the test set (n = 33,628), 1-SD increases in SDOH and PRS were associated with CHD in models that adjusted for clinical risk factors (OR: 1.32; 95% CI: 1.23-1.41 and OR: 1.36; 95% CI: 1.28-1.44, respectively). SDOH and PRS were associated with incident CHD events (n = 52) over a median follow-up of 214 days (Q1-Q3: 88 days). 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. Our findings suggest that including both PRS and SDOH in CHD risk models could improve their accuracy.
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2024.06.052