Community affluence, insurance mediate CV mortality among Black, white cancer survivors
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Key takeaways:
- Black survivors of cancer experienced greater risk for CV mortality vs. white survivors.
- Excess risk was observed based on neighborhood socioeconomic and patient insurance status.
Insurance and neighborhood socioeconomic status were significant mediators of inequity in CV mortality among Black and white cancer survivors, according to a study published in the International Journal of Epidemiology.
Regardless of cancer type, Black patients continued to experience greater risk for CV mortality compared with their white survivor counterparts, according to the study.
“Cancer survivors are at a higher risk of cardiovascular disease than the general population because of cardiotoxicities of cancer treatments, shared risk factors or both,” Hyuna Sung, PhD, senior principal scientist and cancer epidemiologist in surveillance and health equity science at the American Cancer Society, and colleagues wrote. “Prior studies documented considerable Black-white inequities in CVD incidence or mortality among cancer survivors. ... This study aimed to comprehensively examine Black-white inequities in CVD mortality among survivors of 18 adult-onset cancers in the USA and quantify to what extent the effect of race on CVD mortality is mediated by socioeconomic and clinical factors.”
Using 17 Surveillance, Epidemiology and End Results registries, Sung and colleagues identified 904,995 survivors of 18 different cancer subtypes.
The researchers conducted mediation analyses to measure the effects of various potential mediators of inequities in CV mortality among Black and white cancer survivors, including socioeconomic and clinical factors.
During a median follow-up of 43 months, 10,701 CV deaths occurred.
Mortality risk difference by race
Black survivors experienced greater risk for CV mortality across all 18 cancer subtypes compared with white survivors, ranging from a 30% greater risk for those with lung cancer (HR = 1.3; 95% CI, 1.15-1.47) to a more than 400% greater risk for those with brain cancer (HR = 4.04; 95% CI, 2.79-5.83).
The indirect mediating effects of socioeconomic and clinical factors ranged from 24.8% for brain cancer (95% CI, –5.2 to 59.6) to 99.8% for lung cancer (95% CI, 61-167).
Neighborhood socioeconomic status was ranked as the strongest mediator between race and CV mortality for all cancers except for uterine corpus cancer, with the mediation ranging from 25% for kidney cancer to 63.5% for lung cancer. Insurance status was ranked as the second strongest mediator for all cancers except for myeloma and liver, pancreatic and cervical cancers, ranging from 12.3% for leukemia to 31.3% for thyroid cancer, according to the study.
“Where you live shouldn’t determine if you live, but unfortunately that’s the reality for far too many people,” Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network, the American Cancer Society’s advocacy affiliate, said in a press release. “Successfully fighting cancer depends on access to timely, high-quality, affordable health care coverage and treatment. This study underscores the importance of ensuring that everyone has equitable access to high-quality affordable health care, which includes expanding Medicaid in the 10 remaining states that have not done so. This would cover more than 2 million uninsured people who fall into Medicaid coverage gap — nearly 30% of whom are Black.”
Among clinical factors, stage at diagnosis and differences in the receipt of surgery significantly mediated the association between race and risk for CV mortality among cancer survivors. The mediating effect of receipt of chemotherapy or radiotherapy was relatively small for all cancer types, according to the study.
Implications for guidelines
“The findings have implications for clinical guidelines for evaluating cardiovascular risk and prognosis among individuals with a history of cancer,” Sung said in the release. “Although it is well established that incorporating social determinants of health into screening and interventions for cardiovascular care significantly improves patient outcomes, current guidelines concerning cardiovascular health and risk management among cancer survivors mostly omit social determinants of health-informed approaches. These guidelines can be updated to incorporate social determinants of health-informed practices and to help providers identify and address their patient’s social needs.”
Reference:
- New study shows Black cancer survivors face increased mortality from heart disease; neighborhood socioeconomic status and insurance contributing factors. https://www.eurekalert.org/news-releases/996146. Published July 20, 2023. Accessed July 24, 2023.
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