Top

BMC Public Health

Published in:

Open Access 01-12-2024 | Research

Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis

Authors: Ansley J. Kunnath, Daniel E. Sack, Consuelo H. Wilkins

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

Although sociodemographic characteristics are associated with health disparities, the relative predictive value of different social and demographic factors remains largely unknown. This study aimed to describe the sociodemographic characteristics of All of Us participants and evaluate the predictive value of each factor for chronic diseases associated with high morbidity and mortality.

Methods

We performed a cross-sectional analysis using de-identified survey data from the All of Us Research Program, which has collected social, demographic, and health information from adults living in the United States since May 2018. Sociodemographic data included self-reported age, sex, gender, sexual orientation, race/ethnicity, income, education, health insurance, primary care provider (PCP) status, and health literacy scores. We analyzed the self-reported prevalence of hypertension, coronary artery disease, any cancer, skin cancer, lung disease, diabetes, obesity, and chronic kidney disease. Finally, we assessed the relative importance of each sociodemographic factor for predicting each chronic disease using the adequacy index for each predictor from logistic regression.

Results

Among the 372,050 participants in this analysis, the median age was 53 years, 59.8% reported female sex, and the most common racial/ethnic categories were White (54.0%), Black (19.9%), and Hispanic/Latino (16.7%). Participants who identified as Asian, Middle Eastern/North African, and White were the most likely to report annual incomes greater than $200,000, advanced degrees, and employer or union insurance, while participants who identified as Black, Hispanic, and Native Hawaiian/Pacific Islander were the most likely to report annual incomes less than $10,000, less than a high school education, and Medicaid insurance. We found that age was most predictive of hypertension, coronary artery disease, any cancer, skin cancer, diabetes, obesity, and chronic kidney disease. Insurance type was most predictive of lung disease. Notably, no two health conditions had the same order of importance for sociodemographic factors.

Conclusions

Age was the best predictor for the assessed chronic diseases, but the relative predictive value of income, education, health insurance, PCP status, race/ethnicity, and sexual orientation was highly variable across health conditions. Identifying the sociodemographic groups with the largest disparities in a specific disease can guide future interventions to promote health equity.

Available only for authorised users

Centers for Disease Control and Prevntion. Chronic diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. Accessed 15 Oct 2023.

Centers for Disease Control and Prevention. Social determinants of health. https://www.cdc.gov/about/sdoh/index.html.

Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.

U.S. Department of Health and Human Services. Social determinants of health. https://health.gov/healthypeople/priority-areas/social-determinants-health.

Singh PGK, Daus MAGP, Allender MSBSNRNM, et al. Social determinants of health in the United States: Addressing major health inequality trends for the nation, 1935–2016. Int J Mch Aids. 2018;6(2):139–64. https://doi.org/10.21106/ijma.236.CrossRef

Aggarwal R, Chiu N, Wadhera RK, et al. Racial/ethnic disparities in hypertension prevalence, awareness, treatment, and control in the United States, 2013 to 2018. Hypertension. 2021;78(6):1719–26. https://doi.org/10.1161/HYPERTENSIONAHA.121.17570.CrossRefPubMed

Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci. 2014;348(2):135–8. https://doi.org/10.1097/MAJ.0000000000000308.CrossRefPubMedPubMedCentral

Puckrein GA, Egan BM, Howard G. Social and medical determinants of cardiometabolic health: The big picture. Ethn Dis. 2015;25(4):521–4. https://doi.org/10.18865/ed.25.4.521.CrossRefPubMedPubMedCentral

Mital R, Bayne J, Rodriguez F, Ovbiagele B, Bhatt DL, Albert MA. Race and ethnicity considerations in patients with coronary artery disease and stroke: JACC focus seminar 3/9. J Am Coll Cardiol. 2021;78(24):2483–92. https://doi.org/10.1016/j.jacc.2021.05.051.CrossRefPubMed

10.

Đoàn LN, Takata Y, Hooker K, Mendez-Luck C, Irvin VL. Trends in cardiovascular disease by Asian American, Native Hawaiian, and pacific islander ethnicity, Medicare Health Outcomes Survey 2011–2015. J Gerontol A Biol Sci Med Sci. 2022;77(2):299–309. https://doi.org/10.1093/gerona/glab262.CrossRefPubMed

11.

Brunsgaard E, Wu YP, Grossman D. Melanoma in Skin of Color: Part I. Epidemiology and clinical presentation. J Am Acad Dermatol. 2022. https://doi.org/10.1016/j.jaad.2022.04.056.

12.

Brunsgaard E, Jensen J, Grossman D. Melanoma in Skin of Color: Part II. Racial disparities, role of UV, and interventions for earlier detection. J Am Acad Dermatol. 2022. https://doi.org/10.1016/j.jaad.2022.04.057.

13.

Shao K, Feng H. Racial and Ethnic Healthcare Disparities in Skin Cancer in the United States: A Review of Existing Inequities, Contributing Factors, and Potential Solutions. J Clin Aesthet Dermatol. 2022;15(7):16–22.PubMedPubMedCentral

14.

Özdemir BC, Dotto GP. Racial Differences in Cancer Susceptibility and Survival: More Than the Color of the Skin? Trends Cancer. 2017;3(3):181–97. https://doi.org/10.1016/j.trecan.2017.02.002.CrossRefPubMedPubMedCentral

15.

Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537–48. https://doi.org/10.1007/s10549-019-05340-7.CrossRefPubMed

16.

Coughlin SS. Social determinants of colorectal cancer risk, stage, and survival: a systematic review. Int J Colorectal Dis. 2020;35(6):985–95. https://doi.org/10.1007/s00384-020-03585-z.CrossRefPubMed

17.

Adie Y, Kats DJ, Tlimat A, et al. Neighborhood disadvantage and lung cancer incidence in ever-smokers at a safety net health-care system: A retrospective study. Chest. 2020;157(4):1021–9. https://doi.org/10.1016/j.chest.2019.11.033.CrossRefPubMed

18.

Pleasants RA, Riley IL, Mannino DM. Defining and targeting health disparities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2016;11:2475–96. https://doi.org/10.2147/COPD.S79077.CrossRefPubMedPubMedCentral

19.

Pinkerton KE, Harbaugh M, Han MK, et al. Women and lung disease. Sex differences and global health disparities. Am J Respir Crit Care Med. 2015;192(1):11–6. https://doi.org/10.1164/rccm.201409-1740PP.CrossRefPubMedPubMedCentral

20.

Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5 Suppl):101S-56S. https://doi.org/10.1177/1077558707305409.CrossRefPubMedPubMedCentral

21.

Hill-Briggs F, Adler NE, Berkowitz SA, et al. Social determinants of health and diabetes: A scientific review. Diabetes Care. 2020;44(1):258–79. https://doi.org/10.2337/dci20-0053.CrossRefPubMedPubMedCentral

22.

Clark ML, Utz SW. Social determinants of type 2 diabetes and health in the United States. World J Diabetes. 2014;5(3):296–304. https://doi.org/10.4239/wjd.v5.i3.296.CrossRefPubMedPubMedCentral

23.

Krueger PM, Reither EN. Mind the gap: race/ethnic and socioeconomic disparities in obesity. Curr Diab Rep. 2015;15(11):95. https://doi.org/10.1007/s11892-015-0666-6.CrossRefPubMedPubMedCentral

24.

Rossen LM, Schoendorf KC. Measuring health disparities: trends in racial-ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the United States, 2001–2010. Ann Epidemiol. 2012;22(10):698–704. https://doi.org/10.1016/j.annepidem.2012.07.005.CrossRefPubMedPubMedCentral

25.

Chu CD, Powe NR, McCulloch CE, et al. Trends in chronic kidney disease care in the US by race and ethnicity, 2012–2019. JAMA Netw Open. 2021;4(9):e2127014. https://doi.org/10.1001/jamanetworkopen.2021.27014.CrossRefPubMedPubMedCentral

26.

Norton JM, Moxey-Mims MM, Eggers PW, et al. Social determinants of racial disparities in CKD. J Am Soc Nephrol. 2016;27(9):2576–95. https://doi.org/10.1681/ASN.2016010027.CrossRefPubMedPubMedCentral

27.

Nicholas S, Agodoa L, Norris K. Ethnic disparities in the prevalence and treatment of kidney disease. Nephrol News Issues. 2004;18(12):29–30, 32, 34 passim.PubMed

28.

Nicholas SB, Kalantar-Zadeh K, Norris KC. Racial disparities in kidney disease outcomes. Semin Nephrol. 2013;33(5):409–15. https://doi.org/10.1016/j.semnephrol.2013.07.002.CrossRefPubMedPubMedCentral

29.

Nicholas SB, Kalantar-Zadeh K, Norris KC. Socioeconomic disparities in chronic kidney disease. Adv Chronic Kidney Dis. 2015;22(1):6–15. https://doi.org/10.1053/j.ackd.2014.07.002.CrossRefPubMedPubMedCentral

30.

Pourat N, Chen X, Lu C, et al. The Relative Contribution of Social Determinants of Health Among Health Resources and Services Administration-Funded Health Centers. Population Health Manage. 2022;25(2):199–208. https://doi.org/10.1089/pop.2021.0293.CrossRef

31.

National, Program IoHAoUR. FAQ. https://allofus.nih.gov/about/faq. Accessed 15 Oct 2023.

32.

All of Us Research Program I, Denny JC, Rutter JL, et al. The “All of Us” Research Program. N Engl J Med. 2019;381(7):668–76. https://doi.org/10.1056/NEJMsr1809937.CrossRef

33.

Willens DE, Kripalani S, Schildcrout JS, et al. Association of brief health literacy screening and blood pressure in primary care. J Health Commun. 2013;18 Suppl 1(sup1):129–42. https://doi.org/10.1080/10810730.2013.825663.CrossRefPubMed

34.

Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36(8):588–94.PubMed

35.

Team RC. R: A Language and Environment for Statistical Computing. https://www.R-project.org/. Accessed 15 Oct 2023.

36.

Research NIoHAoU, Program. Precision Medicine Initiative: Privacy and Trust Principles. https://allofus.nih.gov/protecting-data-and-privacy/precision-medicine-initiative-privacy-and-trust-principles. Accessed 15 Oct 2023.

37.

Harrell FE. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. New York: Springer International Publishing; 2015.

38.

Harrell Jr FE. Rms: Regression Modeling Strategies. https://CRAN.R-project.org/package=rms. Accessed 15 Oct 2023.

39.

Lumley T. Survey: Analysis of Complex Survey Samples. https://CRAN.R-project.org/package=survey. Accessed 15 Oct 2023.

40.

Reig J. (Very) Basic Steps to Weight a Survey Sample. https://bookdown.org/jespasareig/Book_How_to_weight_a_survey/. Accessed 15 Oct 2023.

41.

Schillinger D. Social Determinants, Health Literacy, and Disparities: Intersections and Controversies. Health Lit Res Pract. 2021;5(3):e234–43. https://doi.org/10.3928/24748307-20210712-01.CrossRefPubMedPubMedCentral

42.

Osborn CY, Cavanaugh K, Wallston KA, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011;16 Suppl 3(Suppl 3):268–78. https://doi.org/10.1080/10810730.2011.604388.CrossRefPubMed

43.

Eneanya ND, Winter M, Cabral H, et al. Health Literacy and Education as Mediators of Racial Disparities in Patient Activation Within an Elderly Patient Cohort. J Health Care Poor Underserved. 2016;27(3):1427–40. https://doi.org/10.1353/hpu.2016.0133.CrossRefPubMedPubMedCentral

44.

Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.CrossRefPubMed

45.

Bennett IM, Chen J, Soroui JS, White S. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204–11. https://doi.org/10.1370/afm.940.CrossRefPubMedPubMedCentral

46.

Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PLoS ONE. 2015;10(12):e0145455. https://doi.org/10.1371/journal.pone.0145455.CrossRefPubMedPubMedCentral

47.

Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int. 2019;34(5):e1–17. https://doi.org/10.1093/heapro/day062.CrossRefPubMed

48.

Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health literacy impact on national healthcare utilization and expenditure. Int J Health Policy Manag. 2015;4(11):747–55. https://doi.org/10.15171/ijhpm.2015.151.CrossRefPubMedPubMedCentral

49.

Mackey LM, Doody C, Werner EL, Fullen B. Self-management skills in chronic disease management: What role does health literacy have? Med Decis Making. 2016;36(6):741–59. https://doi.org/10.1177/0272989X16638330.CrossRefPubMed

50.

Cajita MI, Cajita TR, Han H-R. Health literacy and heart failure. J Cardiovasc Nurs. 2016;31(2):121–30. https://doi.org/10.1097/jcn.0000000000000229.CrossRefPubMedPubMedCentral

51.

Puente-Maestu L, Calle M, Rodríguez-Hermosa JL, et al. Health literacy and health outcomes in chronic obstructive pulmonary disease. Respir Med. 2016;115:78–82. https://doi.org/10.1016/j.rmed.2016.04.016.CrossRefPubMed

52.

Liu L, Qian X, Chen Z, He T. Health literacy and its effect on chronic disease prevention: evidence from China’s data. BMC Public Health. 2020;20(1):690. https://doi.org/10.1186/s12889-020-08804-4.CrossRefPubMedPubMedCentral

53.

Sun Q, Graff M, Rowland B, et al. Analyses of biomarker traits in diverse UK biobank participants identify associations missed by European-centric analysis strategies. J Hum Genet. 2022;67(2):87–93. https://doi.org/10.1038/s10038-021-00968-0.CrossRefPubMed

54.

Manolio TA. Using the Data We Have: Improving Diversity in Genomic Research. Am J Hum Genet. 2019;105(2):233–6. https://doi.org/10.1016/j.ajhg.2019.07.008.CrossRefPubMedPubMedCentral

55.

Tsao CW, Vasan RS. Cohort Profile: The Framingham Heart Study (FHS): overview of milestones in cardiovascular epidemiology. Int J Epidemiol. 2015;44(6):1800–13. https://doi.org/10.1093/ije/dyv337.CrossRefPubMedPubMedCentral

56.

Bureau USC. U.S. Census Bureau QuickFacts. https://www.census.gov/quickfacts/fact/table/US/RHI825221. Accessed 15 Oct 2023.

57.

Hackett RA, Ronaldson A, Bhui K, Steptoe A, Jackson SE. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020;20(1):1652. https://doi.org/10.1186/s12889-020-09792-1.CrossRefPubMedPubMedCentral

58.

Mays VM, Cochran SD, Barnes NW. Race, race-based discrimination, and health outcomes among African Americans. Annu Rev Psychol. 2007;58:201–25. https://doi.org/10.1146/annurev.psych.57.102904.190212.CrossRefPubMedPubMedCentral

59.

Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057–72. https://doi.org/10.17179/excli2017-480.CrossRefPubMedPubMedCentral

60.

Mariotti A. The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Sci OA. 2015;1(3):FSO23. https://doi.org/10.4155/fso.15.21.CrossRefPubMedPubMedCentral

61.

Rappaport SM, Smith MT. Epidemiology. Environment and disease risks Science. 2010;330(6003):460–1. https://doi.org/10.1126/science.1192603.CrossRefPubMed

62.

Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–10. https://doi.org/10.3945/jn.109.112573.CrossRefPubMedPubMedCentral

63.

Smith GS, Breakstone H, Dean LT, Thorpe RJ. Impacts of Gentrification on Health in the US: a Systematic Review of the Literature. J Urban Health. 2020;97(6):845–56. https://doi.org/10.1007/s11524-020-00448-4.CrossRefPubMedPubMedCentral

64.

Smith GS, McCleary RR, Thorpe RJ. Racial Disparities in Hypertension Prevalence within US Gentrifying Neighborhoods. Int J Environ Res Public Health. 2020;17(21). https://doi.org/10.3390/ijerph17217889.

65.

Alang S. Police Brutality and the Institutional Patterning of Stressors. Am J Public Health. 2020;110(11):1597–8. https://doi.org/10.2105/AJPH.2020.305937.CrossRefPubMedPubMedCentral

66.

Hawkins DS. “After Philando, I Had to Take a Sick Day to Recover”: Psychological Distress, Trauma and Police Brutality in the Black Community. Health Commun. 2022;37(9):1113–22. https://doi.org/10.1080/10410236.2021.1913838.CrossRefPubMed

Title: Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis
Authors: Ansley J. Kunnath
Daniel E. Sack
Consuelo H. Wilkins
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17834-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Relative predictive value of sociodemographic factors for chronic diseases among All of Us participants: a descriptive analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Prevalence and association of compliance with the Canadian 24-hour movement guidelines with sociodemographic aspects in Brazilian adults: a cross-sectional epidemiological study

A large, multi-center survey assessing health, social support, literacy, and self-management resources in patients with heart failure

What may encourage or deter health services utilization by people living with or at the risk of HIV/AIDS in special health centers? Qualitative evidence from a stigmatized community

Modeling COVID-19 spread using multi-agent simulation with small-world network approach

A study on the influencing factors of mental health of Chinese garden workers: a cross-sectional study

Impact of psychosocial work factors on risk of medically certified sick leave due to common mental disorders: a nationwide prospective cohort study of Norwegian home care workers