Social Determinants of Health Mediate Racial Disparities in Cardiovascular Disease in Men With Prostate Cancer

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-06-01 DOI:10.1016/j.jaccao.2024.04.004

Biniyam G. Demissei MD, MSC, PhD , Kyunga Ko MS , Anran Huang BA , Daniel J. Lee MD, MS , Abigail G. Doucette MPH , Amanda M. Smith BA, MA , Nicholas S. Wilcox MD, MHS , Jacob Reibel MD , Lova Sun MD, MSCE , Manuj Agarwal MD , Naomi B. Haas MD , Genevieve Hollis CRNP , Jason E. Shpilsky MD , Samuel U. Takvorian MD, MS , David J. Vaughn MD , Jinbo Chen PhD , Rebecca A. Hubbard PhD , Tiffany Powell-Wiley MD, MPH , Clyde Yancy MD, MSc , Vivek Narayan MD, MSCE , Bonnie Ky MD, MSCE

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引用次数: 0

Abstract

Background

Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in men with prostate cancer; however, data on racial disparities in CVD outcomes are limited.

Objectives

We quantified the disparities in CVD according to self-identified race and the role of the structural social determinants of health in mediating disparities in prostate cancer patients.

Methods

A retrospective cohort study of 3,543 prostate cancer patients treated with systemic androgen deprivation therapy (ADT) between 2008 and 2021 at a quaternary, multisite health care system was performed. The multivariable adjusted association between self-reported race (Black vs White) and incident major adverse cardiovascular events (MACE) after ADT initiation was evaluated using cause-specific proportional hazards. Mediation analysis determined the role of theme-specific and overall social vulnerability index (SVI) in explaining the racial disparities in CVD outcomes.

Results

Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; P < 0.001). The association with Black race was strongest for incident heart failure (HR: 1.79; 95% CI: 1.32-2.43), cerebrovascular disease (HR: 1.98; 95% CI: 1.37-2.87), and peripheral artery disease (HR: 1.76; 95% CI: 1.26-2.45) (P < 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.

Conclusions

Black patients are significantly more likely to experience adverse CVD outcomes after systemic ADT compared with their White counterparts. These disparities are mediated by socioeconomic status and other structural determinants of health as captured by census tract SVI. Our findings motivate multilevel interventions focused on addressing socioeconomic vulnerability.

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健康的社会决定因素对前列腺癌男性患者心血管疾病的种族差异具有中介作用

背景心血管疾病（CVD）是导致男性前列腺癌患者发病和死亡的一个重要原因；然而，有关心血管疾病结果的种族差异的数据却很有限。目的我们量化了根据自我认同的种族而存在的心血管疾病差异，以及健康的结构性社会决定因素在前列腺癌患者差异中的中介作用。方法对2008年至2021年间在一家四级多地点医疗保健系统接受全身性雄激素剥夺疗法（ADT）治疗的3543名前列腺癌患者进行了一项回顾性队列研究。采用特定病因比例危险度评估了自报种族（黑人与白人）与ADT开始后发生的主要不良心血管事件（MACE）之间的多变量调整关联。中介分析确定了特定主题和总体社会脆弱性指数（SVI）在解释心血管疾病结果的种族差异中的作用。结果黑种人与 MACE 风险增加有关（HR：1.38；95% CI：1.16-1.65；P <；0.001）。发生心力衰竭（HR：1.79；95% CI：1.32-2.43）、脑血管疾病（HR：1.98；95% CI：1.37-2.87）和外周动脉疾病（HR：1.76；95% CI：1.26-2.45）与黑人种族的关系最为密切（P <0.001）。SVI，特别是社会经济地位主题，介导了黑人和白人患者之间 98% 的 MACE 风险差异。这些差异受社会经济地位和人口普查区 SVI 所反映的其他健康结构性决定因素的影响。我们的研究结果促使我们采取多层次干预措施，重点解决社会经济脆弱性问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.