Associations of perceived discrimination with health outcomes and health disparities in the All of Us cohort

ObjectiveThe goal of this study was to investigate the association of perceived discrimination with health outcomes and disparities. Materials and MethodsThe study cohort consists of 60,180 participants from the four largest SIRE groups in the All of Us Research Program participant body: Asian (1,291), Black (4,726), Hispanic (5,336), and White (48,827). A perceived discrimination index (PDI) was derived from participant responses to the "Social Determinants of Health" survey, and the All of Us Researcher Workbench was used to analyze associations and mediation effects of PDI and self-identified race and ethnicity (SIRE) with 1,755 diseases. ResultsThe Black SIRE group has the greatest median PDI, followed by the Asian, Hispanic, and White groups. The Black SIRE group shows the greatest number of diseases with elevated risk relative to the White reference group, followed by the Hispanic and Asian groups. PDI was found to be positively and significantly associated with 489 out of 1,755 (27.86%) diseases. Mental Disorders is the disease category with the greatest proportion of diseases positively and significantly associated with PDI: 59 out of 72 (81.94%) diseases. Mediation analysis showed that PDI mediates 69 out of 351 (19.66%) Black-White disease disparities. DiscussionPerceived discrimination is significantly associated with risk for numerous diseases and mediates Black-White disease disparities in the All of Us participant cohort. ConclusionThis work highlights the role of discrimination as an important social determinant of health and provides a means by which it can be quantified and modeled on the All of Us platform.