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Social Determinants of Health Mediate Racial Disparities in Cardiovascular Disease in Men With Prostate Cancer 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
IF 11.1 1区 医学 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

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.

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。
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引用次数: 0
Neighborhood Archetypes and Cardiovascular Health 邻里原型与心血管健康
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2024.05.004
Arnethea L. Sutton PhD, MS , Nickolas Stabellini BS , Avirup Guha MD, MPH
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引用次数: 0
Understanding Race, Genotype, and Socioeconomic Status in Transthyretin Amyloid Cardiomyopathy 了解转甲状腺素淀粉样心肌病的种族、基因型和社会经济地位
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2024.05.006
Trejeeve Martyn MD, MSc , Julia M. Simkowski MD , Mazen Hanna MD
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引用次数: 0
Full Issue PDF 全期 PDF
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/S2666-0873(24)00196-0
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引用次数: 0
Walk Your Way Out of Cardiovascular Risk 用步行摆脱心血管风险
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2024.04.005
Ashish Kumar MD , Sourbha S. Dani MD, MSc , Sarju Ganatra MD
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引用次数: 0
Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities 健康知识普及、个人和社区参与以及心血管风险和差异
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2024.03.010
Lauren L. Taylor MD , Arthur S. Hong MD, MPH , Kristine Hahm MPP , Dohyeong Kim PhD , Carolyn Smith-Morris PhD , Vlad G. Zaha MD, PhD

Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient’s perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.

心血管病和癌症的治疗效果在心肿瘤科幸存者护理领域相互交织,其特点是不同民族、种族、社会和地域之间存在差异。尽管临床界越来越意识到这一复杂问题,但有效的解决方案却遥遥无期。为了对公共健康产生重大影响,癌症类型检查和心血管风险缓解需要采取互补的方法,从患者的角度出发,将其扩展到人群层面,并重点关注可操作的人群健康干预措施。采用这种多学科方法将加深我们对患者意识、动机、健康知识和社区资源的了解,以应对心血管肿瘤学的独特挑战。地理空间分析有助于在更细和更广的范围内确定有需要的关键社区。在本综述中,我们勾勒出了一条从个人到社区的障碍路径。从这些角度收集到的数据对于为干预措施提供信息至关重要,这些干预措施可增强不同社区中个人的能力并改善心脏肿瘤学幸存者的生存状况。
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引用次数: 0
Cardio-Oncology Care Delivery for All Patients With Cancer Within Academic and Community Settings 在学术和社区环境中为所有癌症患者提供肿瘤心脏病治疗服务
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2023.10.010
Linda A. Jacobs PhD, CRNP , Lawrence N. Shulman MD
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引用次数: 0
Editorial Board/Officers Page 编辑委员会/官员页面
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/S2666-0873(24)00162-5
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引用次数: 0
Embracing the Power of the Polysocial Risk Score 拥抱多社会风险评分的力量
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2023.10.001
Khurram Nasir MD, MPH, MSc, Zulqarnain Javed PhD, MBBS, MPH, Sadeer Al-Kindi MD
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引用次数: 0
Social Determinants of Health in Cardio-Oncology 心脏肿瘤学中的健康社会决定因素
IF 11.1 1区 医学 Pub Date : 2024-06-01 DOI: 10.1016/j.jaccao.2024.02.009
Foster Osei Baah MS, PhD, RN , Sonal Sharda MHS , Kimberly Davidow MD , Sadhana Jackson MD , Daphney Kernizan DO , Joshua A. Jacobs PharmD , Yvonne Baumer PharmD, PhD , Corinna L. Schultz MD , Carissa M. Baker-Smith MD, MPH , Tiffany M. Powell-Wiley MD, MPH

Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.

要满足对更公平的心外科肿瘤治疗的需求,就必须关注心外科肿瘤疾病预防和治疗效果方面的现有差距。这对于那些受到不利的社会健康决定因素(SDOH)影响的人群尤为重要。社会政治、经济和文化因素影响着 SDOH、癌症诊断以及与肿瘤治疗相关的心脏毒性结果之间错综复杂的关系。此外,细胞信号传导机制和基因表达的表观遗传效应将不利的 SDOH 与癌症和肿瘤治疗引起的心血管疾病相关并发症联系在一起。为了减少这些差异,需要采取多方面的策略,包括关注医疗保健的获取、政策和社区参与,以改善疾病筛查和管理。跨学科团队还必须提高文化谦逊性和能力,并利用新的医疗技术促进合作,以应对不利的 SDOH 对心血管肿瘤治疗结果的影响。
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Jacc: Cardiooncology
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