Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2024 Nov 26;84(22):2157-2166. doi: 10.1016/j.jacc.2024.06.052.
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.
健康的社会决定因素（SDOH）会影响冠心病（CHD）等常见疾病的发病风险。
本研究旨在检验自报种族/民族、SDOH 和多基因风险评分（PRS）与美国大型和多样化人群中 CHD 的相关性。
在 67256 名有可用 SDOH 和全基因组测序数据的“所有人”（AoU）参与者中，我们确定了自报种族/民族和 5 个 SDOH 领域的 22 个 SDOH 指标，并计算了 CHD 的 PRS（PRS，PGS004696）。我们开发了一个 CHD 的 SDOH 评分（SDOH）。我们在包含临床危险因素的回归模型中检验了 SDOH 和 PRS 与 CHD 的相关性。
5 个领域的 SDOH，包括食物不安全、收入、教育程度、健康素养、邻里混乱和孤独，与 CHD 相关。自报为黑人和西班牙裔的人 SDOH 最高。与白人相比，自报为黑人的人患 CHD 的几率更高，但在调整 SDOH 后则不然。SDOH 和 PRS 相关性较弱。在验证集（n=33628）中，在调整临床危险因素的模型中，SDOH 和 PRS 的 1-SD 增加与 CHD 相关（OR：1.32；95%CI：1.23-1.41 和 OR：1.36；95%CI：1.28-1.44）。SDOH 和 PRS 与中位随访 214 天（Q1-Q3：88 天）内发生的 CHD 事件相关（n=52）。
自报为黑人的人患 CHD 的几率增加可能是由于 SDOH 负担增加所致。SDOH 和 PRS 与 CHD 独立相关。我们的研究结果表明，在 CHD 风险模型中同时纳入 PRS 和 SDOH 可能会提高其准确性。
