Evaluating Minority Representation in the All of Us Research Program: Progress and Ongoing Challenges.

Abstract

Objectives. To evaluate trends in racial and ethnic representation in the All of Us (AoU) Research Program from 2017 to 2023 and assess regional disparities relative to US Census benchmarks. Methods. Using the AoU data repository, we compared yearly and cumulative racial/ethnic representation with 2020 US Census data. Odds ratios (ORs) were calculated to quantify underrepresentation by group, year, region, and sex at birth. Results. Non-Hispanic White individuals accounted for the largest percentage of the 619 830 participants (56.3%), followed by non-Hispanic Blacks (15.9%), Hispanics (14.9%), Asians (3.5%), and individuals in the multiracial/other category (9.4%). Asians and Hispanics were consistently underrepresented. Regional disparities were notable: Asian representation was lowest in the West (OR = 0.48; 95% confidence interval [CI] = 0.47, 0.49), and Hispanic underrepresentation was most pronounced in the South (OR = 0.54; 95% CI = 0.53, 0.55). Conclusions. Persistent underrepresentation of Asian and Hispanic participants highlights ongoing gaps as AoU recruitment continues. Continued efforts toward equitable participation will be important for achieving the scientific and ethical goals of precision medicine.