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A new study published in The American Journal of Human Genetics found that social determinants of health, including environmental conditions, health behaviors, access to resources, and social well-being, can predict disease risk as well as or better than genetic risk scores for several common diseases. Researchers say combining social and genetic factors may lead to more accurate risk assessment and prevention strategies.
Advances in genetic testing have fueled hopes that DNA could help predict who will develop chronic disease. But a new study suggests genetic risk scores may tell only part of the story.
Using data from the National Institutes of Health’s All of Us Research Program, researchers at the Icahn School of Medicine at Mount Sinai examined how social, behavioral, environmental, and genetic factors interact to influence disease risk.
For four of the six diseases studied, social, behavioral, and environmental factors contributed as much as, or more than, commonly used genetic risk scores.
The findings reinforce what many nurses have observed for years: factors such as housing stability, food access, transportation, social support, and neighborhood conditions can significantly influence health outcomes long before a patient arrives at a hospital or clinic.
Looking Beyond DNA
Researchers evaluated six common conditions:
- Asthma
- Chronic kidney disease
- Coronary heart disease
- High cholesterol
- Breast cancer
- Prostate cancer
Adding social determinants of health to disease prediction models significantly improved risk assessment compared with relying solely on genetics.
The finding challenges the idea that genetics alone can provide the clearest picture of future health risk.
“Genes are an important part of the equation, but they do not determine destiny,” says senior corresponding author Samira Asgari, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai. “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.”
Loneliness Emerges as a Potential Risk Signal
Among the study’s more notable observations was the association between disease risk and factors that have historically received less attention in genetic research, including loneliness.
The study was not designed to determine whether loneliness directly causes disease. However, researchers say the finding highlights an area that warrants 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 finding comes as healthcare organizations and public health experts continue to examine the impact of social isolation on physical and mental health outcomes.
Why the Findings Matter for Nurses
The study arrives as healthcare systems increasingly emphasize screening for social determinants of health, including housing instability, food insecurity, transportation barriers, social isolation, and access to care.
Nurses are often the clinicians most likely to uncover these challenges during routine care, making them well-positioned to identify social factors that affect disease risk. Questions about housing, food security, transportation, social support, and access to follow-up care frequently arise during assessments, discharge planning, care coordination, and community health outreach.
The study suggests that social and environmental information collected during patient assessments may provide important insights into disease risk alongside genetic factors, giving nurses another lens for prevention and care planning.
Rather than focusing on a handful of known risk factors, researchers analyzed more than 100 survey-based and community-level measures related to social and environmental conditions. Their framework identified broader patterns across people’s lives and evaluated how those patterns influenced disease risk, offering insights that could strengthen prevention efforts and risk assessment.
What the Study Does Not Show
The researchers caution that the findings should not be interpreted as proof that any single social factor directly causes disease.
Because many survey responses were collected at a single point in time, the study cannot determine whether specific social experiences occurred before disease development. Instead, the research identifies associations that may help improve future risk assessment efforts.
The authors emphasize that disease risk is shaped by complex interactions among genetic, environmental, behavioral, and social influences.
A New Approach to Understanding Risk
Researchers say the framework could help improve population health research, disease prevention strategies, and future efforts to personalize care by integrating genetic, social, and environmental factors into risk assessment.
“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.”
As healthcare increasingly embraces genetic testing and personalized approaches to care, the findings suggest that understanding a patient’s social circumstances remains a critical part of assessing health risk.
For nurses, the findings reinforce a reality they often see firsthand: a patient’s health is shaped not only by biology, but also by the conditions in which they live, work, and connect with others.
