Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research

Chandler, Paulette D.; Clark, Cheryl R.; Zhou, Guohai; Noel, Nyia L.; Achilike, Confidence; Mendez, Lizette; Ramirez, Andrea H.; Loperena-Cortes, Roxana; Mayo, Kelsey; Cohn, Elizabeth; Ohno-Machado, Lucila; Boerwinkle, Eric; Cicek, Mine S.; Qian, Jun; Schully, Sheri D.; Ratsimbazafy, Francis; Mockrin, Stephen; Gebo, Kelly A.; Dedier, Julien; Murphy, Shawn N.; Smoller, Jordan W.; Karlson, Elizabeth W.

doi:10.1038/s41598-021-92143-w

Cited by 7 publications

(3 citation statements)

References 32 publications

(33 reference statements)

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“…We utilized data collected using the All of Us Researcher Workbench, a cloud-based platform for use by approved researchers [ 17 ]. The data includes surveys, EHR data, and physical measurements (PM).…”

Section: Methodsmentioning

confidence: 99%

“…Participants could choose not to answer specific questions. PM recorded at enrollment include systolic and diastolic blood pressure, height, weight, heart rate, waist and hip measurement, wheelchair use, and current pregnancy status [ 17 ]. The program includes participants of different ethnicity/race, age, and geographic areas in the USA, as well as different education, income, gender identity, and health status [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…PM recorded at enrollment include systolic and diastolic blood pressure, height, weight, heart rate, waist and hip measurement, wheelchair use, and current pregnancy status [ 17 ]. The program includes participants of different ethnicity/race, age, and geographic areas in the USA, as well as different education, income, gender identity, and health status [ 17 ]. The All of Us Research Program emphasizes the importance of social determinants of health and addressing the health of underserved populations.…”

Section: Methodsmentioning

confidence: 99%

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Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program

Devineni

Akbarpour

Gong

et al. 2022

Cardiovasc Drugs Ther

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Purpose Data are limited on sodium glucose co-transport 2 inhibitors (SGLT2-is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among real-world cohorts of underrepresented patients. We examined these therapies and glycemic control in US adults with diabetes mellitus (DM) by atherosclerotic cardiovascular disease (ASCVD) risk and sociodemographic factors. Methods In the NIH Precision Medicine Initiative All of Us Research Program, we categorized DM as (1) moderate risk, (2) high risk, and (3) with ASCVD. We examined proportions on DM therapies, including SGLT2-i or GLP-1 RA, and at glycemic control by sociodemographic factors and CVD risk groups. Results Our 81,332 adults aged ≥ 18 years with DM across 340 US sites included 22.3% non-Hispanic Black, 17.2% Hispanic, and 1.8% Asian participants; 31.1%, 30.3%, and 38.6% were at moderate risk, high risk, or with ASCVD, respectively. Those with DM and ASCVD were most likely on SGLT2-i (8.6%) or GLP-1 RA (11.9%). SGLT2-i use was < 10% in those with heart failure or chronic kidney disease. The odds (95% CI) of SGLT2-i use were greater among men (1.35 [1.20, 1.53]) and Asian persons (2.31 [1.78, 2.96]), with GLP-1 RA being less common (0.78 [0.70, 0.86]) in men. GLP-1 RA use was greater among those with health insurance, and both GLP-1 RA and SGLT2-i greater within lower income groups. 72.0% of participants had HbA1c < 7%; Hispanic persons were least likely at glycemic control. Conclusions Treatment with SGLT2-is and GLP-1 RAs remains low, even among higher ASCVD risk persons with DM and use is even lower among underserved groups.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program

Devineni

Akbarpour

Gong

et al. 2022

Cardiovasc Drugs Ther

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Contextual Deprivation, Race and Ethnicity, and Income in Air Pollution and Cardiovascular Disease

Luo,

Craver,

Jin

et al. 2024

JAMA Netw Open

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ImportanceSocioeconomically disadvantaged subpopulations are more vulnerable to fine particulate matter (PM2.5) exposure. However, as prior studies focused on individual-level socioeconomic characteristics, how contextual deprivation modifies the association of PM2.5 exposure with cardiovascular health remains unclear.ObjectiveTo assess disparities in PM2.5 exposure association with cardiovascular disease among subpopulations defined by different socioeconomic characteristics.Design, Setting, and ParticipantsThis cohort study used longitudinal data on participants with electronic health records (EHRs) from the All of Us Research Program between calendar years 2016 and 2022. Statistical analysis was performed from September 25, 2023, through February 23, 2024.ExposureSatellite-derived 5-year mean PM2.5 exposure at the 3-digit zip code level according to participants’ residential address.Main Outcome and MeasuresIncident myocardial infarction (MI) and stroke were obtained from the EHRs. Stratified Cox proportional hazards regression models were used to estimate the hazard ratio (HR) between PM2.5 exposure and incident MI or stroke. We evaluated subpopulations defined by 3 socioeconomic characteristics: contextual deprivation (less deprived, more deprived), annual household income (≥$50 000, &lt;$50 000), and race and ethnicity (non-Hispanic Black, non-Hispanic White). We calculated the ratio of HRs (RHR) to quantify disparities between these subpopulations.ResultsA total of 210 554 participants were analyzed (40% age &gt;60 years; 59.4% female; 16.7% Hispanic, 19.4% Non-Hispanic Black, 56.1% Non-Hispanic White, 7.9% other [American Indian, Asian, more than 1 race and ethnicity]), among whom 954 MI and 1407 stroke cases were identified. Higher PM2.5 levels were associated with higher MI and stroke risks. However, disadvantaged groups (more deprived, income &lt;$50 000 per year, Black race) were more vulnerable to high PM2.5 levels. The disparities were most pronounced between groups defined by contextual deprivation. For instance, increasing PM2.5 from 6 to 10 μg/m3, the HR for stroke was 1.13 (95% CI, 0.85-1.51) in the less-deprived vs 2.57 (95% CI, 2.06-3.21) in the more-deprived cohort; 1.46 (95% CI, 1.07-2.01) in the $50 000 or more per year vs 2.27 (95% CI, 1.73-2.97) in the under $50 000 per year cohort; and 1.70 (95% CI, 1.35-2.16) in White individuals vs 2.76 (95% CI, 1.89-4.02) in Black individuals. The RHR was highest for contextual deprivation (2.27; 95% CI, 1.59-3.24), compared with income (1.55; 95% CI, 1.05-2.29) and race and ethnicity (1.62; 95% CI, 1.02-2.58).Conclusions and RelevanceIn this cohort study, while individual race and ethnicity and income remained crucial in the adverse association of PM2.5 with cardiovascular risks, contextual deprivation was a more robust socioeconomic characteristic modifying the association of PM2.5 exposure.

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Moving to Equity in the All of Us Research Program

Ferryman,

Goldenberg,

Sabatello

2024

The American Journal of Bioethics

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Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research

Cited by 7 publications

References 32 publications

Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program

Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program

Contextual Deprivation, Race and Ethnicity, and Income in Air Pollution and Cardiovascular Disease

Moving to Equity in the All of Us Research Program

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