A Comparison of Chronic Disease Prevalence using All of Us (AOU), National Health Interview Surveillance (NHIS) and National Health and Nutrition Examination Survey (NHANES) Datasets in the Years 2022-2023

Abstract

Background: Chronic diseases remain a primary public health problem in the United States, with disparities enduring across a wide range of racial and ethnic populations. This study assesses the generalizability of the All of Us (AoU) Research Program by analyzing the prevalence of chronic conditions with those from two national surveillance systems – National Health Interview Survey (NHIS) and National Health And Nutrition Examination Survey (NHANES). Methods: A cross sectional analysis was performed using data from AoU, NHIS and NHANES compiled from years 2022 and 2023. Six chronic conditions were analyzed: hypertension, stroke, prediabetes, diabetes, myocardial infarction, cancer, asthma. Prevalence estimates and ratios were computed by overall and stratified by race/ethnicity with a focus on differences of sampling, demographics and collection approaches. Results: AoU reported higher or similar estimates for chronic conditions relative to NHIS and NHANES especially for stroke, prediabetes, diabetes, myocardial infarction and asthma. In contrast, hypertension and cancer prevalence was lower in AoU. Racial and ethnic disparities were apparent across these datasets, with underrepresented populations for Black and AIAN populations experiencing a higher burden for many conditions. Conclusions: These findings indicate that AoU, despite convenience sample methods, provide comparable and occasionally higher chronic disease prevalence than traditional surveillance systems. These results draw attention to the need for methodological considerations in generalizing findings from AoU to the broader US population. The study emphasizes the value of inclusive and representative data to better understand and address health disparities.