ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK IN UNDERREPRESENTED POPULATIONS: INSIGHTS FROM THE ALL OF US RESEARCH PROGRAM

Abstract

Therapeutic Area: ASCVD/CVD Risk Factors Background: Racial, ethnic, and gender orientation minorities experience a disproportionate burden of atherosclerotic cardiovascular disease (ASCVD) but are less represented in research. We sought to investigate the association between demographics, clinical risk factors, and social determinants of health with ASCVD in the All of Us Research Program, a national cohort that seeks to study underrepresented populations. Methods: This study used data from the All of Us Research Program's Controlled Tier Dataset Version 7, available to authorized users on the Researcher Workbench. We queried the All of Us database for adult individuals from 2017 to 2024 with completed data on demographics, social determinants, clinical risk factors, and area deprivation index (ADI). ASCVD was defined using ICD-10 codes for coronary artery disease (I20 – I25) and stroke (I63, I65). Clinical risk factors were defined using ICD-10 codes and included type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia. Tobacco use and obesity were defined using survey responses and body mass index greater than 30 kg/m2, respectively. Multivariate logistic regression was performed to test the association between predictors and ASCVD [reported odds ratios (OR), 95% confidence interval (CI)]. Results: There were 251,116 individuals included, with 59.8% female, 41.0% non-White race, 17.1% Hispanic or Latino or other ethnicity, and 52.2% with annual income below $50,000. There were 31,011 individuals with ASCVD (12.3%). Baseline characteristics in the ASCVD group included average age 69.4, 14,672 (47.3%) female, 9,788 (31.6%) non-White race, 3,683 (11.9%) Hispanic or Latino or other ethnicity, 16,383 (52.8%) with annual income below $50,000, and 2,345 (7.6%) with less than a high school degree. Risk factors prevalences in this group included 12,840 (41.4%) with T2DM, 25,809 (83.2%) with hypertension, 24,806 (80%) with hyperlipidemia, 14,464 (46.6%) with obesity, and 4,563 (14.7%) that reported tobacco use. In adjusted multivariate models, age, male gender, transgender, non-binary or other gender, Black race, Native Hawaiian Pacific Islander race, low annual incomes (<$50,000), several higher decile area deprivation indices, and traditional medical risk factors except obesity were associated with ASCVD (Table 1). Conclusions: Several underrepresented groups, including Black individuals, Native Hawaiian and Pacific Islanders, and those identifying as transgender, non-binary or other gender, as well as those with poorer social determinants of health such as lower annual incomes and higher decile deprivation indices, were more likely to have prevalent ASCVD in this All of Us cohort.