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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Hubbard PhD , Tiffany Powell-Wiley MD, MPH , Clyde Yancy MD, MSc , Vivek Narayan MD, MSCE , Bonnie Ky MD, MSCE","doi":"10.1016/j.jaccao.2024.04.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Objectives</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; <em>P</em> < 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) (<em>P <</em> 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":48499,"journal":{"name":"Jacc: Cardiooncology","volume":"6 3","pages":"Pages 390-401"},"PeriodicalIF":12.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666087324001480/pdfft?md5=b0f8efa70d99a66abc283d1cbfae2d03&pid=1-s2.0-S2666087324001480-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Social Determinants of Health Mediate Racial Disparities in Cardiovascular Disease in Men With Prostate Cancer\",\"authors\":\"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\",\"doi\":\"10.1016/j.jaccao.2024.04.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Objectives</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; <em>P</em> < 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) (<em>P <</em> 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.</p></div><div><h3>Conclusions</h3><p>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. 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Social Determinants of Health Mediate Racial Disparities in Cardiovascular Disease in Men With Prostate Cancer
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.
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.
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