Socio-environmental context in monoclonal gammopathy of undetermined significance (MGUS)
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African Americans have a more than 2-fold higher incidence of multiple myeloma (MM) and its asymptomatic precursor condition, monoclonal gammopathy of undetermined significance (MGUS) compared to individuals from other racial/ethnic groups. However, the etiological factors for MGUS/MM are not known and few epidemiologic resources are currently available to support research in high-risk populations. Notably, there is little evidence that genetic factors explain these differences; differences in prevalence of MGUS and MM among population groups may thus reflect external lifestyle and other factors. We posit that these population differences are reflected in individual-level financial and educational status and geospatial factors such as the “health” of the geographic areas in which one lives (termed “built environment”), both of which are known to be linked a variety of health outcomes. The Black Women's Health Study (BWHS) and the California Teachers Study (CTS), well-established complementary cohorts, provide a unique opportunity to study these potential risk factors for MGUS in a demographically representative population with up to 25 years of individual-level risk factor information, assessed through repeated health questionnaires, available as well as geocoded residential addresses. We propose an epidemiologic study pooling data from these two cohorts to evaluate the role of individual- and neighborhood-level income and education and the built environment (measured as walkability and urbanicity) in population differences in MGUS. Prevalent cases of MGUS will be identified by screening 8,000 cohort participants (3,300 in BWHS and 4,700 in CTS) with archived blood specimens using gold-standard laboratory assays for the diagnosis of MGUS; we expect to identify 660 cases of MGUS. We hypothesize that neighborhood differences and attributes of the built environment that inhibit healthy behaviors increase risk of MGUS. We will determine associations of area-level factors and educational achievement, parental education level, income, and early life financial instability, in relation to MGUS. We will also explore how characteristics of the built environment, such as urbanicity and neighborhood walkability, and the cross- classification of these variables with financial standing, are associated with MGUS and may explain observed differences in prevalence. Our proposed study is particularly innovative because it moves beyond the traditional, single-level predictor model to an approach that addresses the complexity of both individual- and contextual- level predictors for disease. The wide geographic/rural-urban and economic representativeness of our study population across cohorts makes it an ideal setting in which to interrogate the intersection between education, income, and area-level attributes on MGUS and MM risk. This research therefore has great potential to advance current knowledge about MGUS etiology and to inform opportunities for risk reduction in high-risk populations.
