Associations Between Social Determinants of Health and Cardiovascular Health of U.S. Adult Cancer Survivors.

Background: Relationships between the social determinants of health (SDOH) and cardiovascular health (CVH) of cancer survivors are underexplored.
Objectives: This study sought to investigate associations between the SDOH and CVH of adult cancer survivors.
Methods: Data from the U.S. National Health Interview Survey (2013-2017) were used. Participants reporting a history of cancer were included, excluding those with only nonmelanotic skin cancer, or with missing data for any domain of SDOH or CVH. SDOH was quantified with a 6-domain, 38-item score, consistent with the Centers for Disease Control and Prevention recommendations (higher score indicated worse deprivation). CVH was quantified based on the American Heart Association's Life's Essential 8, but due to unavailable detailed dietary data, a 7-item CVH score was used, with a higher score indicating worse CVH. Survey-specific multivariable Poisson regression was used to test associations between SDOH quartiles and CVH.
Results: Altogether, 8,254 subjects were analyzed, representing a population of 10,887,989 persons. Worse SDOH was associated with worse CVH (highest vs lowest quartile: risk ratio 1.30; 95% CI: 1.25-1.35; P  < 0.001), with a grossly linear relationship between SDOH and CVH scores. Subgroup analysis found significantly stronger associations in younger participants ( P _interaction  = 0.026) or women ( P _interaction  = 0.001) but without significant interactions with race ( P _interaction  = 0.051). Higher scores in all domains of SDOH were independently associated with worse CVH (all  P  < 0.001). Higher SDOH scores were also independently associated with each component of the CVH score (all  P  < 0.05 for highest SDOH quartile).
Conclusions: An unfavorable SDOH profile was independently associated with worse CVH among adult cancer survivors in the United States.
Competing Interests: This work was partly supported by the Tianjin Key Medical Discipline (Specialty) Construction Project (Project number: TJYXZDXK-029A) and by a grant from the Hong Kong Metropolitan University (Project Reference No. RIF/2022/2.2). The funder played no role in any part of this study. Dr Dee is funded in part through the Cancer Center Support Grant from the National Cancer Institute (P30 CA008748). Dr Sharma is supported by the Blumenthal Scholarship in Preventive Cardiology at the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins University School of Medicine and American Heart Association grant 979462. Dr Virani has received grant support from the Department of Veterans Affairs, the World Heart Federation, and the Tahir and Jooma Family; and honoraria from the American College of Cardiology (Associate Editor for Innovations). Dr Shapiro has served on scientific advisory boards for Amgen, Ionis, Novartis, and Precision BioScience; and as a consultant for Ionis, Novartis, Regeneron, EmendoBio, and Aidoc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2024 The Authors.)