Social Determinants of Cardiovascular Disease in US Women with and without Breast Cancer

Abstract

AbstractBackgroundSocial determinants of health (SDOH) may be related to CV risk in women with and without breast cancer (BC).MethodsIn 153,401 women without prevalent CV disease in the Women’s Health Initiative (WHI), SDOH factors included geographic region, rurality, insurance status, and household income. Cox proportional hazard models were used to assess associations between SDOH factors and a composite CV outcome (myocardial infarction, stroke, hospitalization for heart failure, or CV death). Effect modification by BC was assessed between BC status and SDOH.ResultsThe final cohort included 10,954 (mean age 62±7 years) women who subsequently developed BC and 142,144 (mean age 63 ± 7) women without BC. During a median follow-up of 13 years, 18,148 women had an incident composite CV outcome. Rurality, low household income, and non-private insurance were associated with an increased risk of composite CV outcome and mortality in both women with and without BC. There was no effect modification by BC status for associations with rurality, insurance, or household income. By geographic region, there was no difference in composite CV outcome in women without BC. However, there was a significant interaction by BC status for geographic region and the composite endpoint (p=0.009). Women with BC in the South had a lower risk of the composite outcome (HR 0.68, 95% CI 0.54-0.87).ConclusionsSDOH are associated with an increased risk of CV events and mortality among women. There were no differential associations based on BC status, suggesting that women with BC face similar vulnerabilities related to SDOH.