1277-OR: Social Determinants of Health Score and Risk of Coronary Heart Disease in a Diverse Cohort of People with Type 2 Diabetes

Introduction and Objective: We examined the association between a composite social determinant of health (SDOH) score and incident coronary heart disease (CHD), adjusting for genetic susceptibility to CHD and traditional risk factors, among adults with T2D. Methods: We used data from 71,916 All of Us Research Program (AoU) participants with T2D who are free of CHD. SDOH included race and 21 measures across five domains: economic stability, education access and quality, health and health care, neighborhood and built environment, and social and community context. Missing SDOH survey items were imputed using random forests with predictive mean matching. A weighted, standardized SDOH-CHD score was developed using an elastic-net model. Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for incident CHD per 1-SD increase in the SDOH-CHD score and across tertiles, adjusting for age at T2D diagnosis, current age, sex, race, antidiabetic, antihypertensive, and lipid-lowering medications, and a polygenic risk score for CHD. Linearity was evaluated using restricted cubic splines. Results: In a median follow-up of 6.6 years, 7,643 people developed CHD. Each 1-SD higher SDOH-CHD score was associated with a 32% higher CHD risk (HR 1.33; 95% CI 1.30-1.36). Compared with the lowest SDOH tertile, adjusted HRs were 1.48 (95% CI 1.40-1.58) for the middle tertile and 1.90 (95% CI 1.78-2.02) for the highest tertile (p-trend <0.001). Spline models suggested an approximately linear relationship between SDOH score and CHD risk. Conclusion: A higher SDOH score is independently associated with increased CHD risk in people with T2D. Incorporating SDOH risk assessment into diabetes care may improve CHD prevention strategies. Disclosure D. Li: None. Y. Lu: None. S. Chu: None. R.L. Horswell: None. Y. Yoshida: None. Funding American Diabetes Association (7-23-JDFWH-10), National Institute of General Medical Sciences of the National Institutes of Health (1P20GM152305), Administrative Supplement of the Louisiana Clinical & Translational Science Center (U54 GM104940)