Mount Sinai study connects social determinants of health to disease risks

A new study from the Icahn School of Medicine at Mount Sinai shows that social determinants of health-including environmental conditions, health behaviors, access to resources, and social well-being-can play an equally important or even greater role than genetics in predicting a person's risk of developing common diseases.

Published in the June 22 online issue of The American Journal of Human Genetics [DOI: 10.1016/j.ajhg.2026.05.014], the study, titled "Integrating Social Determinants of Health and Genetic Risk in Disease Risk Models," examined how inherited genetic risk and social, behavioral, and environmental factors interact to influence disease risk across diverse populations.

Using data from the All of Us Research Program-a nationwide National Institutes of Health (NIH) initiative-researchers analyzed genetic information, electronic health records, and survey responses from participants across the United States. They evaluated six common conditions: asthma, chronic kidney disease, coronary heart disease, high cholesterol, breast cancer, and prostate cancer.

The researchers found that incorporating social determinants of health significantly improved disease risk prediction beyond genetics alone. For four of the six diseases studied, social, behavioral, and environmental factors contributed as much as, or more than, commonly used genetic risk scores.

Genes are an important part of the equation, but they do not determine destiny. We found that the circumstances of people's lives-their environments, behaviors, and social experiences-can contribute as much as genetics to predicting disease risk. To truly understand health, we have to look at the whole person, not just their DNA."

Samira Asgari, PhD, senior corresponding author, Assistant Professor of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai

The findings highlight the complex factors that shape health and disease. While advances in genetics have expanded researchers' ability to estimate inherited risk, the new findings suggest that combining genetic information with social and environmental context may provide a more complete understanding of disease risk and help inform future prevention strategies.

To conduct the study, researchers analyzed more than 100 survey-based and community-level measures related to social and environmental conditions. Rather than focusing on a handful of predefined risk factors, the team developed a framework that identifies broader patterns across many aspects of people's lives and evaluates how those patterns contribute to disease risk.

Among the notable findings, the researchers observed associations between disease risk and factors that are less frequently examined in genetic and biological research, including loneliness. While the study was not designed to determine cause and effect, the findings highlight areas that warrant further investigation.

"Some risk factors, such as smoking, have been studied extensively for decades," says first author Abhijith Biji, a PhD student in the Asgari lab who led the work. "What is especially intriguing is that we also observed associations involving factors like loneliness. Understanding how these experiences may become biologically embedded could open new avenues for research and ultimately improve our understanding of disease."

The authors emphasize that the study does not identify simple causes of disease and should not be interpreted as showing that any single factor directly leads to illness. Also, because many of the survey responses were collected at a single point in time, the research cannot determine whether a particular factor preceded the onset of disease.

Instead, the researchers say, the study provides a framework for integrating genetic and non-genetic information to build more comprehensive disease risk models.

The researchers believe this approach could strengthen population health research, improve disease prevention strategies, enhance risk assessment, and support future efforts to develop more personalized approaches to health care. Future studies will explore how social determinants of health can be integrated with additional biological measures and investigate the biological mechanisms that may connect social experiences to disease.

"Our goal is to build a more complete understanding of health and disease," says Dr. Asgari. "By combining genetics with social and environmental context, we can move toward risk models that better reflect the realities of people's lives and help advance more personalized approaches to health."

The authors, as listed in the journal, are Abhijith Biji, Kathleen Ferar, Vikas Pejaver, Eimear E. Kenny, Bian Liu, and Samira Asgari.

This work was supported in part by NIH grants: R21MD019104 and R35GM160530 and the Clinical and Translational Science Awards (CTSA) grant UL1TR004419 from the National Center for Advancing Translational Sciences. Research reported in the publication was also supported by the Office of Research Infrastructure of the National Institutes of Health under award numbers S10OD026880 and S10OD030463.