Neighborhood Disadvantage and Genetic Testing Use Among a Nationally Representative Sample of US Adults

Introduction: Genetic testing helps individuals with disease management, family planning, and medical decision-making. Identifying individual-level factors related to the use of genetic services is essential but may only partially explain differential genetic service usage. To address this knowledge gap, we analyzed data on a national sample of US adults to evaluate whether higher neighborhood vulnerability is significantly associated with lower genetic testing utilization, controlling for sociodemographic and health characteristics. Methods: A 2024 nationally representative cross-sectional survey of 631 US adults recruited using NORC’s probability-based AmeriSpeak panel. Genetic testing uptake was measured as self-reported ever use of ancestry, personal trait, specific disease, or prenatal genetic carrier testing. Secondary outcomes were indicator variables for each genetic testing type. Neighborhood vulnerability (low versus high) was measured by the Social Vulnerability Index, capturing socioeconomic factors affecting community resilience to natural hazards and disasters. Results: Forty-eight percent of the weighted sample used genetic testing services. Compared to those in low vulnerability areas, individuals in high vulnerability areas had 42% lower odds (adjusted OR: 0.58, 95% CI: 0.37-0.90) of using genetic testing services, controlling for individual-level characteristics. Secondary analyses showed no evidence of statistically significant relationships between neighborhood vulnerability and specific types of genetic testing services. Conclusion: Findings suggest that neighborhood vulnerability may contribute to differences in genetic testing uptake, which is crucial to increasing early detection of cancer susceptibility and reducing US cancer incidence. This study demonstrates the importance of going beyond examining individual characteristics to investigating structural factors negatively impacting genetic testing usage.