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

Abstract

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.

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.

Keywords: coronary heart disease; polygenic risk scores; social determinants of health.