Chan Jeffrey Shi Kai, Satti Danish Iltaf, Ching Yat Long Anson, Lee Quinncy, Dee Edward Christopher, Ng Kenrick, Chou Oscar Hou-In, Liu Tong, Tse Gary, Lai Agnes
Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Kowloon, Hong Kong, China.
School of Nursing and Health Sciences, Hong Kong Metropolitan University, 1 Sheung Shing Street, Quarry Hill, Kowloon, Hong Kong, China.
Eur J Prev Cardiol. 2025 Mar 18;32(4):336-347. doi: 10.1093/eurjpc/zwae318.
The cause-specific mortality implications of social determinants of health (SDOH) in cancer survivors were unclear. This study aimed to explore associations between SDOH and cardiovascular and cancer mortality in cancer survivors.
Data from 2013 to 2017 National Health Interview Survey were used for this prospective cohort study. Social determinants of health were quantified using a 38 point, 6 domain score, with higher points indicating worse deprivation. Associations between SDOH and outcomes (primary: cardiovascular mortality; secondary: cancer and all-cause mortality) were assessed using cause-specific multivariable Cox regression, with cancer survivors and individuals without cancer modelled separately. Post hoc analyses were performed among cancer survivors to explore associations between each domain of SDOH and the risks of outcomes. Altogether, 37 882 individuals were analysed (4179 cancer survivors and 33 703 individuals without cancer). Among cancer survivors, worse SDOH was associated with higher cardiovascular [adjusted hazard ratio (aHR) 1.31 (1.02-1.68)], cancer [aHR 1.20 (1.01-1.42)], and all-cause mortality [aHR 1.16 (1.02-1.31)] when adjusted for demographics, comorbidities, and risk factors. Among individuals without cancer, SDOH was associated with cardiovascular mortality and all-cause when only adjusted for demographics, but not when further adjusted for comorbidities and risk factors; no associations between SDOH and cancer mortality were found. Among cancer survivors, psychological distress, economic stability, neighbourhood, physical environment and social cohesion, and food insecurity were varyingly associated with the outcomes.
Social determinants of health were independently associated with all-cause, cardiovascular, and cancer mortality among cancer survivors but not among individuals without cancer. Different domains of SDOH may have different prognostic importance.
癌症幸存者中健康的社会决定因素（SDOH）对特定病因死亡率的影响尚不清楚。本研究旨在探讨SDOH与癌症幸存者心血管疾病和癌症死亡率之间的关联。
本前瞻性队列研究使用了2013年至2017年国家健康访谈调查的数据。健康的社会决定因素通过一个38分、6个领域的评分进行量化，分数越高表明贫困程度越严重。使用特定病因的多变量Cox回归评估SDOH与结局（主要结局：心血管疾病死亡率；次要结局：癌症和全因死亡率）之间的关联，分别对癌症幸存者和无癌症个体进行建模。在癌症幸存者中进行事后分析，以探讨SDOH的每个领域与结局风险之间的关联。总共分析了37882名个体（4179名癌症幸存者和33703名无癌症个体）。在癌症幸存者中，在调整人口统计学、合并症和风险因素后，较差的SDOH与较高的心血管疾病[调整后风险比（aHR）1.31（1.02 - 1.68）]、癌症[aHR 1.20（1.01 - 1.42）]和全因死亡率[aHR 1.16（1.02 - 1.31）]相关。在无癌症个体中，仅调整人口统计学时，SDOH与心血管疾病死亡率和全因死亡率相关，但进一步调整合并症和风险因素后则不相关；未发现SDOH与癌症死亡率之间的关联。在癌症幸存者中，心理困扰、经济稳定性、邻里关系、物理环境和社会凝聚力以及粮食不安全与结局存在不同程度的关联。
健康的社会决定因素与癌症幸存者的全因、心血管疾病和癌症死亡率独立相关，但与无癌症个体无关。SDOH的不同领域可能具有不同的预后重要性。
