Social determinants of health in cancer survivors and the risk of cardiovascular events.

Abstract

Aims: The impact of social determinants of health (SDoH) on cardiovascular disease (CVD) risk in cancer survivors remains unclear. We examined the association between SDoH and subsequent CVD risk among cancer survivors.

Methods: This retrospective cohort study included 18,992 cancer survivors and 75,968 propensity score-matched non-cancer controls from the UK Biobank. A composite SDoH score was generated using 17 components across 5 domains, classifying participants into favorable, medium, and unfavorable SDoH groups. Cox models were used to assess associations between SDoH and incident CVD, including ischemic heart disease (IHD), heart failure (HF), stroke, and CVD mortality.

Results: Compared with cancer survivors with favorable SDoH, those with medium and unfavorable SDoH had higher CVD risks: hazard ratio (HR) 1.17 (95% CI: 1.09-1.27) and HR 1.32 (95% CI: 1.23-1.43), respectively. Unfavorable SDoH was also associated with increased risk of IHD (HR: 1.31; 95% CI: 1.15-1.49), HF (HR: 1.58; 95% CI: 1.30-1.92), stroke (HR: 1.47; 95% CI: 1.18-1.84), and CVD mortality (HR: 1.54; 95% CI: 1.25-1.90). Cancer survivors with favorable SDoH had overall CVD risks similar to matched non-cancer controls (HR: 1.07; 95% CI: 1.00-1.13). In joint analysis, cancer survivors with favorable SDoH had a higher risk (HR: 1.22; 95% CI, 1.15-1.28) than their non-cancer counterparts.

Conclusion: Among cancer survivors, unfavorable SDoH were associated with elevated CVD risk, whereas favorable SDoH attenuated this risk to levels comparable with non-cancer population. That may partly reflect the increased risk observed among non-cancer with unfavorable SDoH. Targeted interventions and policy measures addressing social determinants are needed to mitigate cardiovascular disparities in cancer survivorship.