Background

Social determinants of health (SDOH) influence the risk of common diseases such as coronary heart disease (CHD).

Objectives

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. cohort.

Methods

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_CHD, PGS004696). We developed an SDOH score for CHD (SDOH_CHD). We tested the associations of SDOH and PRS_CHD with CHD in regression models that included clinical risk factors.

Results

SDOH across 5 domains, including food insecurity, income, educational attainment, health literacy, neighborhood disorder, and loneliness, were associated with CHD. SDOH_CHD 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_CHD. SDOH_CHD and PRS_CHD were weakly correlated. In the test set (n = 33,628), 1-SD increases in SDOH_CHD and PRS_CHD 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_CHD and PRS_CHD were associated with incident CHD events (n = 52) over a median follow-up of 214 days (Q1-Q3: 88 days).

Conclusions

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.

中文翻译：

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自我报告的种族、健康的社会决定因素和多基因风险与冠心病的关联

 背景

健康的社会决定因素 （SDOH） 会影响冠心病 （CHD） 等常见疾病的风险。

 目标

本研究旨在测试自我报告的种族/民族、SDOH 和多基因风险评分 （PRS） 与美国大型多样化队列中 CHD 的关联。

 方法

在拥有可用 SDOH 和全基因组测序数据的 67,256 名我们所有人 （AoU） 参与者中，我们确定了 5 个 SDOH 领域的自我报告的种族/民族和 22 项 SDOH 测量，并计算了 CHD 的 PRS （PRS_CHD， PGS004696）。我们开发了 CHD 的 SDOH 评分 （SDOH_CHD）。我们在包含临床危险因素的回归模型中测试了 SDOH 和 PRS_CHD 与 CHD 的相关性。

 结果

食物不安全、收入、教育程度、健康素养、邻里障碍和孤独感 5 个领域的 SDOH 与 CHD 相关。SDOH_CHD 在自我报告的黑人和西班牙裔人群中最高。自我报告为黑人患 CHD 的几率高于白人，但在调整 SDOH_CHD 后没有。SDOH_CHD 和 PRS_CHD 呈弱相关。在测试集 （n = 33,628） 中，在调整临床危险因素的模型中，SDOH_CHD 和 PRS_CHD 的 1-SD 增加与 CHD 相关（分别为 OR：1.32;95% CI：1.23-1.41 和 OR：1.36;95% CI：1.28-1.44）。SDOH_CHD 和 PRS_CHD 与中位随访 214 天 （Q1-Q3： 88 d） 的 CHD 事件相关 （n = 52）。

 结论

自我报告为黑人的人患 CHD 的几率增加可能是由于 SDOH 负担较高。SDOH 和 PRS 与 CHD 独立相关。我们的研究结果表明，在 CHD 风险模型中同时包括 PRS 和 SDOH 可以提高其准确性。