Relationship Between Census Tract-Level Social Determinants of Health and Cardiovascular Care among Individuals Diagnosed With Breast Cancer.

Purpose: Cardiovascular care is impacted by social determinants of health (SDoH), however implications for physician visits among individuals diagnosed with breast cancer (BC) who received potentially cardio-toxic treatments (PCT) are poorly understood. We investigate these relationships among older adults.

Methods: This study used Surveillance, Epidemiology, and End Results-Medicare data linked with Census tract SDoH measures. We included female patients diagnosed with BC between 2007 and 2018 who received PCT within 12 months of diagnosis. Framework-guided tract-level SDoH variables and empirically-derived tract-level SDoH domains were used in separate regression models. Study outcomes included cardiologist or primary care physician (PCP) visits within 90 days of treatment and time to first physician visit. Logistic regression and Cox proportional hazards models included patient- and tract-level measures.

Results: A total of 2637 patients were included. Living in a low food access tract (aOR: 0.78, 95%CI: 0.63-0.96) and a primary care health professional shortage area (aOR: 0.66, 95%CI: 0.52-0.84) were associated with lower odds of first cardiologist visit within 90 days of treatment. Living in a tract ranked higher on the empirical domain of "poor community infrastructure and inequity" was associated with a longer time to a first cardiologist visit (aHR: 0.90, 95%CI: 0.81-0.99).

Conclusions: Individuals residing in worse-off tracts experienced barriers to physician visits following PCT initiation. "poor community infrastructure and inequity," was associated with a longer time to first cardiologist visit. These findings support incorporating contextual SDoH factors into pretreatment risk assessment tools to better identify patients who may benefit from cardio-oncology referrals.