Social determinants linked to ‘dramatic differences’ in heart health for cancer survivors
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Among adult cancer survivors in the United States, a suboptimal social determinants of health profile had an independent association with worse cardiovascular health, according to a study published in JACC: CardioOncology.
“The interaction between social determinants of health and cardiovascular health has always been of great clinical and academic interest, which was further highlighted by a recently published statement on social determinants of cardiovascular health,” study co-lead author Danish Iltaf Satti, MBBS, postdoctoral research fellow at Johns Hopkins University School of Medicine, told Healio.
“While reviewing the literature, we felt that the relationship between social determinants of health and the cardiovascular health of cancer survivors was missing,” Satti added. “As we know, survivors of cancer are affected by financial toxicity and various other socioeconomic issues. So, we wanted to look at this vulnerable population specifically.”
Satti and co-lead Jeffrey Shi Kai Chan, MBChB, MPH, researcher at the Cardiovascular Analytics Group in Hong Kong, discussed their study, its findings and the potential implications for the future of this population of cancer survivors.
Healio: What inspired you to conduct this study?
Satti: We are aware of the financial toxicity and other socioeconomic issues cancer survivors face. We also know that cancer survivors are at increased risk for cardiovascular disease, either because of their cancer diagnosis or because of the cardiotoxic effects of some cancer therapies. Therefore, we specifically wanted to explore how the cardiovascular health of cancer survivors correlates with social determinants of health.
Healio: How did you conduct this study?
Satti: We used data obtained from the U.S. National Health Interview Survey spanning the years 2013 to 2017. To quantify the social determinants of health, we used a six-domain, 38-item score, with a higher score indicating worse deprivation. Cardiovascular health was analyzed using a simplified version of American Heart Association’s Life Essential 8, in the form of a seven-item cardiovascular health score, with a higher score representing worse cardiovascular health.
Healio: What did you find?
Satti: Our study found that the worse the social determinants of health profile, the worse the cardiovascular health score, with dramatic differences between the highest and the lowest quartile of social determinants of health. Specifically, those cancer survivors with the worst social determinants of health had a 30% higher risk for poor cardiovascular health versus those with lower socioeconomic risk.
Additionally, our study found that female and younger study participants showed particularly stronger association between social determinants of health profiles and adverse cardiovascular health.
Healio: What do you think is driving these associations?
Chan: There are many reasons — this is a complicated topic. One might be that cancer survivors may have worse mental health. They tend to have more stress and more psychological distress, which can affect all aspects of health and be one of the mediators. Also, cancer costs a lot of money to treat, and this financial deprivation might affect a survivor’s ability to afford better care in other aspects of their health.
The reason we did this research and took the approach we did was not necessarily to explain everything. In fact, this study frankly might raise more questions than answers. I think the main point of this was to show that social deprivation is strongly related to cardiovascular health. The data we have in the National Health Interview Survey is great, but it’s not enough for us to understand the mechanisms that are driving the association. There is definitely more research that needs to be done on this topic.
Healio: Are there any factors at the provider level that might impact cardiovascular health in cancer survivors?
Chan: We did some exploratory analysis within this study, looking at the correlations between social determinants of health and having previous health checks within the past year. We didn’t find any correlation, so I don’t think that is necessarily a factor that mediated the differences. That said, the exploratory nature of this analysis precludes definitive conclusions.
Satti: We found that there was no association between increased health checkups and poor cardiovascular health in cancer survivors. Still, at the provider level, I believe there is generally insufficient knowledge and education about the social determinants of health, and that might contribute as a factor. When providers are not well equipped with information about what social determinants of health to consider in the clinical care of a cancer survivor, they might not be able to account for that. So, we also suggested that one possible strategy could be to have more educational events such as webinars, and clinician education should be focused on the social determinants of health. That might also result in improved reporting of these factors and could ultimately translate into better social determinants of health for cancer survivors as well.
Healio: What else can oncologists do to improve this situation?
Chan: Oncologists can take the initiative of keeping an eye out for those who might be deprived in terms of income, financial stress and psychological health. More importantly, health care for cancer survivors should be holistic and multidisciplinary, specifically involving experts from other fields such as cardiologists, social workers and other health professionals to cover all bases. So, heightened awareness and multidisciplinary care are key.
Satti: I would also mention that since we found that female and younger participants had a stronger association between social determinants of health and adverse cardiovascular health, oncologists could focus more on these specific groups, perhaps watching them more closely.
References:
- Powell-Wiley TM, et al. Circ Res. 2022;doi:10.1161/CIRCRESAHA.121.319811.
- Satti DI, et al. J Am Coll Cardiol CardioOnc. 2023;doi:10.1016/j.jaccao.2023.07.010.
For more information:
Jeffrey Shi Kai Chan, MBChB, MPH, can be reached at jeffreychan.dbs@gmail.com.
Danish Iltaf Satti, MBBS, can be reached at Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287; email: dsatti1@jh.edu.
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