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

Biniyam G Demissei1, Kyunga Ko1, Anran Huang1

  • 1Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

JACC. Cardiooncology
|July 10, 2024
PubMed

Insights

Black men with prostate cancer on androgen deprivation therapy (ADT) face higher cardiovascular disease (CVD) risks. Socioeconomic factors significantly drive these racial disparities, highlighting the need for targeted interventions.

Area of Science:

  • Oncology
  • Cardiology
  • Public Health

Background:

  • Cardiovascular disease (CVD) is a major cause of death in prostate cancer patients.
  • Limited data exist on racial disparities in CVD outcomes among this population.

Purpose of the Study:

  • To quantify racial disparities in CVD outcomes in prostate cancer patients.
  • To investigate the role of structural social determinants of health in mediating these disparities.

Main Methods:

  • Retrospective cohort study of 3,543 prostate cancer patients treated with systemic androgen deprivation therapy (ADT).
  • Evaluation of the association between self-reported race (Black vs. White) and incident major adverse cardiovascular events (MACE) post-ADT.
  • Mediation analysis using the Social Vulnerability Index (SVI) to assess its role in racial disparities.

Main Results:

  • Black race was associated with a significantly increased hazard of MACE (HR: 1.38).
  • Disparities were most pronounced for heart failure, cerebrovascular disease, and peripheral artery disease.
  • The socioeconomic status component of SVI mediated 98% of the MACE risk disparity between Black and White patients.

Conclusions:

  • Black patients experience significantly higher adverse CVD outcomes post-ADT compared to White patients.
  • Racial disparities in CVD outcomes are substantially mediated by socioeconomic status and other structural determinants of health.
  • Multilevel interventions addressing socioeconomic vulnerability are warranted to mitigate these disparities.
Abstract

Keywords:
cardio-oncologydisparityelectronic health recordsprostate cancer

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