Non-medical determinants of health (NMDoH), such as access to transportation, education, and employment, account for an estimated 30-55% of health outcomes and often co-occur, shaping patient risk. However, most research examines these factors independently. Through AIM-AHEAD’s Consortium Development Program, Dr. Suresh Bhavnani is applying human-centered artificial intelligence (AI) to better understand NMDoH clusters and their influence on patient outcomes in cancer care.
Study Design and Methods
Dr. Bhavnani’s study uses data from the All of Us Research Program, including 44,792 cancer participants. The analysis incorporates 110 self-reported NMDoH variables, aggregated into 18 factors across five domains, with outcomes including depression, delayed medical care, and emergency room utilization.
Given substantial and non-random missingness in survey responses, inverse probability weighting was used in place of standard imputation. The study integrates clustering methods to identify NMDoH subtypes with predictive modeling approaches, including logistic regression, random forest, and XGBoost, to evaluate risk across outcomes.
Key Findings
Distinct clusters of co-occurring NMDoH factors were identified, each associated with different outcome profiles. These clusters reflect varying combinations of barriers that correspond to differences in depression, delayed care, and emergency room use.
Predictive performance was strong, with the random forest model achieving an AUC of 0.80 for depression, outperforming prior NMDoH-based models. Model performance varied across clusters, with one subgroup consistently underperforming, suggesting the need for additional variables or subgroup-specific modeling approaches. While traditional and machine learning methods produced consistent overall findings, the clustering approach provided added insight into how combinations of factors contribute to risk.
Implications for Research and Practice
This work highlights how combining AI with real-world data can improve risk stratification by accounting for non-medical factors that influence health. By identifying patterns in patient needs, the study supports more targeted care and better resource alignment.
Findings from this work are also informing ongoing efforts, including collaboration with the Houston Health Department, to translate these insights into practical strategies for care navigation and resource allocation.
Dr. Bhavnani’s work has received national recognition, including selection as a 2025 Presidential Leadership Scholar. He has presented findings at national and international meetings and continues to collaborate with AIM-AHEAD investigators across institutions.