Measuring Social Determinants of Health in the All of Us Research Program: Technical Document

BackgroundTo advance precision medicine and improve population health, the All of Us Research Program aims to collect data, including a survey of social determinants of health (SDOH), from over 1 million participants. This report (1) outlines the process used to construct the All of Us SDOH survey and (2) presents the psychometric characteristics and scoring recommendations for SDOH survey measures. MethodsA consensus process was used to select a definition of SDOH and conceptual frameworks to develop inclusion and exclusion criteria and priorities for construct consideration. Cognitive interviewing was used to provide an assessment of SDOH survey item performance in English and Spanish. Scales and scored items were constructed in alignment with validated literature. Item non-response was calculated, and Cronbach s alpha was used to analyze the psychometric properties of each scale, overall and by demographic characteristics. Multivariable logistic regression models were used to examine if demographic categories were associated with item non-response. ResultsTwenty-nine percent (N=117,783) of All of Us participants submitted SDOH survey data by June 30, 2022. Among those who provided any SDOH survey data, item non-response was infrequent, with most scales having less than 5% incalculable scores due to item non-response. Item non-response varied most along the lines of racial identity, educational attainment, and the language in which the survey was administered (Spanish or English). In our regression models, for most scales, patterns of missing data due to item non-response were seen by racial identity, educational attainment, income level, and age. Internal consistency reliability was greater than 0.80 for almost all scales, with variability by racial identity, educational attainment, and the language of survey administration. ConclusionThe SDOH survey demonstrated good to excellent reliability across several measures of SDOHs and within multiple population groups that are underrepresented in biomedical research. Bias due to survey non-response and item non-response should be monitored and addressed as the survey is fielded more completely.