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.

Beller Tech LLC New York NY United States

Department of Global Health and Population Harvard TH Chan School of Public Health Boston MA United States

Division of Endocrinology Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai New York NY United States

Foundation for Clinic Public Health and Epidemiology Research of Venezuela Caracas Venezuela

Icahn School of Medicine at Mount Sinai New York NY United States

International Clinical Research Center St Anne's University Hospital Brno Czechia

Precision Care Clinic Corp Saint Cloud Saint Cloud FL United States

The Marie Josée and Henry R Kravis Center for Cardiovascular Health at Mount Sinai Fuster Heart Hospital New York NY United States

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