Satti Danish Iltaf, Chan Jeffrey Shi Kai, Dee Edward Christopher, Lee Yan Hiu Athena, Wai Abraham Ka Chung, Dani Sourbha S, Virani Salim S, Shapiro Michael D, Sharma Garima, Liu Tong, Tse Gary
Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong SAR.
Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
JACC CardioOncol. 2023 Oct 24;6(3):439-450. doi: 10.1016/j.jaccao.2023.07.010. eCollection 2024 Jun.
Relationships between the social determinants of health (SDOH) and cardiovascular health (CVH) of cancer survivors are underexplored.
This study sought to investigate associations between the SDOH and CVH of adult cancer survivors.
Data from the U.S. National Health Interview Survey (2013-2017) were used. Participants reporting a history of cancer were included, excluding those with only nonmelanotic skin cancer, or with missing data for any domain of SDOH or CVH. SDOH was quantified with a 6-domain, 38-item score, consistent with the Centers for Disease Control and Prevention recommendations (higher score indicated worse deprivation). CVH was quantified based on the American Heart Association's Life's Essential 8, but due to unavailable detailed dietary data, a 7-item CVH score was used, with a higher score indicating worse CVH. Survey-specific multivariable Poisson regression was used to test associations between SDOH quartiles and CVH.
Altogether, 8,254 subjects were analyzed, representing a population of 10,887,989 persons. Worse SDOH was associated with worse CVH (highest vs lowest quartile: risk ratio 1.30; 95% CI: 1.25-1.35; < 0.001), with a grossly linear relationship between SDOH and CVH scores. Subgroup analysis found significantly stronger associations in younger participants ( = 0.026) or women ( = 0.001) but without significant interactions with race ( = 0.051). Higher scores in all domains of SDOH were independently associated with worse CVH (all < 0.001). Higher SDOH scores were also independently associated with each component of the CVH score (all < 0.05 for highest SDOH quartile).
An unfavorable SDOH profile was independently associated with worse CVH among adult cancer survivors in the United States.
癌症幸存者的健康社会决定因素（SDOH）与心血管健康（CVH）之间的关系尚未得到充分研究。
本研究旨在调查成年癌症幸存者的SDOH与CVH之间的关联。
使用了美国国家健康访谈调查（2013 - 2017年）的数据。纳入报告有癌症病史的参与者，排除仅患有非黑素瘤皮肤癌或SDOH或CVH任何领域数据缺失的参与者。SDOH通过一个6领域、38项的评分进行量化，这与疾病控制和预防中心的建议一致（分数越高表明剥夺越严重）。CVH基于美国心脏协会的生命基本8项指标进行量化，但由于无法获得详细的饮食数据，使用了一个7项的CVH评分，分数越高表明CVH越差。采用特定调查的多变量泊松回归来检验SDOH四分位数与CVH之间的关联。
总共分析了8254名受试者，代表了10887989人的总体。较差的SDOH与较差的CVH相关（最高四分位数与最低四分位数：风险比1.30；95%可信区间：1.25 - 1.35；<0.001），SDOH与CVH评分之间存在大致线性关系。亚组分析发现，在年轻参与者（=0.026）或女性（=0.001）中关联显著更强，但与种族无显著交互作用（=0.051）。SDOH所有领域的较高分数均与较差的CVH独立相关（所有<0.001）。较高的SDOH分数也与CVH评分的每个组成部分独立相关（最高SDOH四分位数时所有<0.05）。
在美国成年癌症幸存者中，不利的SDOH状况与较差的CVH独立相关。
