Bayesian network model of ethno-racial disparities in cardiometabolic-based chronic disease using NHANES 1999-2018

Abstract

Background: Ethno-racial disparities in cardiometabolic diseases are driven by socioeconomic, behavioral, and environmental factors. Bayesian networks offer an approach to analyze the complex interaction of the multi-tiered modifiable factors and non-modifiable demographics that influence the incidence and progression of cardiometabolic disease.

Methods: In this study, we learn the structure and parameters of a Bayesian network based on 20 years of data from the US National Health and Nutrition Examination Survey to explore the pathways mediating associations between ethno-racial group and cardiometabolic outcomes. The impact of different factors on cardiometabolic outcomes by ethno-racial group is analyzed using conditional probability queries.

Results: Multiple pathways mediate the indirect association from ethno-racial group to cardiometabolic outcomes: (1) ethno-racial group to education and to behavioral factors (diet); (2) education to behavioral factors (smoking, physical activity, and-via income-to alcohol); (3) and behavioral factors to adiposity-based chronic disease (ABCD) and then other cardiometabolic drivers. Improved diet and physical activity are associated with a larger decrease in probability of ABCD stage 4 among non-Hispanic White (NHW) individuals compared to non-Hispanic Black (NHB) and Hispanic (HI) individuals.

Conclusion: Education, income, and behavioral factors mediate ethno-racial disparities in cardiometabolic outcomes, but traditional behavioral factors (diet and physical activity) are less influential among NHB or HI individuals compared to NHW individuals. This suggests the greater contribution of unmeasured individual- and/or neighborhood-level structural determinants of health that impact cardiometabolic drivers among NHB and HI individuals. Further study is needed to discover the nature of these unmeasured determinants to guide cardiometabolic care in diverse populations.

Keywords: cardiometabolic disease; health inequities; obesity; racial inequities; social determinants of health.