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. 2024 Apr 16;14(1):8815.
doi: 10.1038/s41598-024-57410-6.

Measuring social determinants of health in the All of Us Research Program

Samantha Tesfaye  1   2 , Robert M Cronin  3 , Maria Lopez-Class  4 , Qingxia Chen  5 , Christopher S Foster  4 , Callie A Gu  6 , Andrew Guide  5 , Robert A Hiatt  7 , Angelica S Johnson  8 , Christine L M Joseph  9 , Parinda Khatri  10 , Sokny Lim  11 , Tamara R Litwin  1 , Fatima A Munoz  12 , Andrea H Ramirez  11 , Heather Sansbury  13   14 , David G Schlundt  15 , Emma N Viera  16 , Elif Dede-Yildirim  11 , Cheryl R Clark  17
Affiliations

Measuring social determinants of health in the All of Us Research Program

Samantha Tesfaye et al. Sci Rep. .

Abstract

To accelerate medical breakthroughs, the All of Us Research Program aims to collect data from over one million participants. This report outlines processes used to construct the All of Us Social Determinants of Health (SDOH) survey and presents the psychometric characteristics of SDOH survey measures in All of Us. A consensus process was used to select SDOH measures, prioritizing concepts validated in diverse populations and other national cohort surveys. Survey item non-response was calculated, and Cronbach's alpha was used to analyze psychometric properties of scales. Multivariable logistic regression models were used to examine associations between demographic categories and item non-response. Twenty-nine percent (N = 117,783) of eligible All of Us participants submitted SDOH survey data for these analyses. Most scales had less than 5% incalculable scores due to item non-response. Patterns of item non-response were seen by racial identity, educational attainment, income level, survey language, and age. Internal consistency reliability was greater than 0.80 for almost all scales and most demographic groups. The SDOH survey demonstrated good to excellent reliability across several measures and within multiple populations underrepresented in biomedical research. Bias due to survey non-response and item non-response will be monitored and addressed as the survey is fielded more completely.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Percentage of participants with incalculable scores due to item non-response by educational attainment. Abbreviations: PANES, Physical Activity and Neighborhood Environment Scale; PNA, prefer not to answer. Data represent the percentage of SDOH survey respondents with an incalculable scale due to item non-response, by educational attainment. Participants who responded to the incorrect response set for the Religious Service Attendance item (N = 11,795) are flagged as ‘invalid’ in version 7 data; these respondents are not included in item non-response calculations.
Figure 2
Figure 2
Percentage of participants with incalculable scores due to item non-response by Racial Identity and language (English and Spanish). Abbreviations: PANES, Physical Activity and Neighborhood Environment Scale; MENA, Middle Eastern or North African; NHPI, Native Hawaiian or Pacific Islander; PNA, prefer not to answer. Black: Black, African or African-American; Hispanic: Hispanic/Latino/Spanish. Data shaded in gray are suppressed due to small sample size < 20. Data represent the percentage of SDOH survey respondents with an incalculable scale due to item non-response, by Racial Identity and Language group. Participants who responded to the incorrect response set for the Religious Service Attendance item (N = 11,795) are flagged as ‘invalid’ in version 7 data; these respondents are not included in item non-response calculations.
Figure 3
Figure 3
Odds of item non-response or incalculable score for any SDOH scale. Abbreviations: PNA, prefer not to answer.
See this image and copyright information in PMC

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