Racial Inequities in Cardiovascular Mortality Persist Among Cancer Survivors

A greater focus on implementing neighborhood-level interventions and ensuring equitable access to care may reduce Black-White inequities in cardiovascular disease (CVD) mortality among cancer survivors, according to the results of a study recently published in the International Journal of Epidemiology.

A team of researchers sought to build upon earlier research that documented considerable inequities in CVD incidence or mortality among Black and White cancer survivors, focusing mainly on survivors of 18 adult-onset cancers. They also sought to quantify the effect of potential mediators such as socioeconomic and clinical factors on mortality.

The researchers identified 1,287,124 non-Hispanic White and non-Hispanic Black survivors of malignant cancers diagnosed between the ages of 20 and 64 years during the 2007-2016 time period from 17 Surveillance, Epidemiology and End Results (SEER) registries. Data from 904,995 survivors with 18 cancer types met inclusion criteria for this analysis.

Proportional hazards models were used to examine associations between race and CVD mortality. Mediation analyses were performed to pinpoint more detail about the contributions of potential mediating factors, such as socioeconomic status factors (eg, health insurance, neighborhood socioeconomic status), as well as clinical factors (such as stage, surgery, and type of treatment).

After 43 months of median follow-up, 7683 (1.0%) White survivors and 3018 (1.9%) Black survivors died of CVDs. According to the analysis, CVD mortality rates were higher among survivors who lacked insurance or Medicaid coverage.

Specifically, Black survivors were less likely to have insurance or be Medicaid beneficiaries, and they were more likely to live in socioeconomically deprived neighborhoods than White survivors (48.8% vs 11.9%). Black survivors were also less likely than White survivors to have undergone surgery (40% vs 29.9%) and to have presented with distant-stage cancer (20.9% vs 16.4%).

A substantial proportion of racial inequities in cardiovascular mortality among US cancer survivors is relative to neighborhood socioeconomic environments, measured via census tract-level composite index, and health care access, measured via insurance status. These findings highlight the intersectionality of race, residential deprivation, and barriers to health care access as underlying pathways to inequities in survivorship, explained the researchers.

“A broader structural approach that improves the neighbourhood environment and equalizes access to care may offer effective solutions towards advancing cardiovascular health equity among cancer survivors,” they concluded.

Reference

Sung H, Huyn N, Ohman RE, Yang EH, Seigel RL, Jemal A. Mediators of Black–White inequities in cardiovascular mortality among survivors of 18 cancers in the USA. Int J Epidemiol. Published online July 30, 2023. doi:10.1093/ije/dyad097