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

Objectives The goal of this study was to investigate the association of perceived discrimination with health outcomes and disparities.Materials and Methods The study cohort consists of 60 180 participants from the 4 largest self-identified race and ethnicity (SIRE) groups in the All of Us Research Program participant body: Asian (1291), Black (4726), Hispanic (5336), 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 SIRE with 1755 diseases.Results The 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. Perceived discrimination index was found to be positively and significantly associated with 489 out of 1755 (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.Discussion Perceived discrimination is significantly associated with risk for numerous diseases and mediates Black-White disease disparities in the All of Us participant cohort.Conclusion This 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.