Structural Racism and Cardiovascular Outcomes Among Cancer Survivors

PROJECT SUMMARY/ABSTRACT Among individuals who survive ≥5-years from a cancer diagnosis, cardiovascular disease (CVD) is the leading cause of death. Black adults with cancer have twice the risk of poor CVD outcomes as White adults with cancer. This disparity is partially due to a higher CVD prevalence among Blacks in the general population, and

greater incidence of cardio-toxic effects from cancer therapies among Blacks, but we hypothesize that social determinants of health (SDOHs) (e.g., area-level structural racism and individual socio-economic position) are also responsible for Black-White CVD disparities. We have shown that having ≥1 adverse SDOH increases

one’s risk of cancer mortality, and Blacks are more likely to have ≥2 SDOHs than Whites (44% vs. 24%). Apart from cancer, ≥1 SDOHs increases one’s risk of coronary heart disease, stroke, and heart failure. Underlying mechanisms of SDOHs that lead to CVD disparities in cancer survivors are not well understood. Structural

racism has policy implications and understanding its role in Black-White CVD disparities can point the way to solutions to reduce disparities. We will use the World Health Organization’s Commission on SDOH framework to investigate relationships between SDOHs and CVD outcomes in Black and White cancer survivors.

The objective of this proposal is to determine the role of SDOH (structural racism and individual socio- economic position) on CVD outcomes among a community-based cohort of 8,000 male and female adults with cancer. We seek to leverage a novel link between data from the REasons for Geographic And Racial

Disparities in Stroke (REGARDS) study to cancer registries from the Virtual Pooled Registry Cancer Linkage System (VPR-CLS). REGARDS is a national, prospective, longitudinal cohort study that recruited 30,239 English-speaking individuals, at least 45-years of age from the 48 contiguous US states (42% Black; 55%

female) in 2003-7 and follows participants today. The VPR, coordinated by the North American Association of Cancer Registries, includes 45 registries covering 95% of the U.S. The novel combination of data sources will leverage area-level structural racism measures and individual-level measures of socio-economic status, cancer

biologic factors, health behaviors, self-rated health, and expert adjudicated CVD outcomes to determine among cancer survivors: 1) associations between SDOH and CVD outcomes; 2) the role of cancer biologic, behavioral, and psychosocial factors in the relationship between SDOH and CVD; and 3) the role of cancer

and non-cancer health service use in the relationship between SDOH and CVD. Our long-term goal is to develop strategies to eliminate White-Black disparities in CVD outcomes in cancer survivors. We have assembled a multi-disciplinary team of experts in CVD and cancer epidemiology, health services research,

cardio-oncology, biostatistics, SDOH, and structural racism. Together, we will generate evidence to inform and develop interventions to eliminate Black-White CVD disparities in cancer survivorship.