A graphical abstract illustrating Dr Agnes Lai's research. Source: 'Associations between social determinants of health and cardiovascular and cancer mortality in cancer survivors: a prospective cohort study', European Journal of Preventive Cardiology. (Licensed under CC BY 4.0)
Cardiovascular diseases and cancer are both prevalent causes of death globally. In 2021, cardiovascular diseases accounted for 19.4 million deaths, while cancer resulted in 9.9 million deaths.[1][2] Although the incidence of both cardiovascular diseases and cancer is on the rise, advancements in treatments and early detection have led to a decrease in cancer mortality rates. These trends have resulted in a growing population of cancer survivors who face higher cardiovascular risks compared to individuals without cancer.
Among the numerous factors affecting cardiovascular health, social determinants of health (SDOH) – non-medical factors influencing health outcomes – are increasingly recognised as significantly influencing cardiovascular health in both the general population and cancer survivors. However, it remains unclear how SDOH specifically contribute to different causes of death in cancer survivors. To address this gap, Dr Agnes Lai, Associate Professor in the School of Nursing and Health Sciences at the Hong Kong Metropolitan University, led a research team to explore the associations between SDOH and cardiovascular and cancer mortality in cancer survivors.
This study utilised data from the 2013 to 2017 National Health Interview Survey of the United States of America and analysed 37,882 individuals, including 4,179 cancer survivors and 33,703 individuals without cancer.
The findings indicated that SDOH strongly influence cardiovascular and cancer mortality in cancer survivors, but not in individuals without cancer. Specifically, psychological distress, a domain of SDOH, was linked to a higher risk of all-cause mortality (the death rate from all possible causes), cardiovascular mortality and cancer mortality. Other SDOH domains, including economic stability, neighbourhood, physical environment, and social cohesion, were associated with higher risks of cardiovascular and all-cause mortality. Conversely, similar connections between SDOH and mortality were observed in individuals without cancer, but these appeared to be more linked to factors such as demographics, existing health conditions, and risk factors.
In addition, the research highlighted psychological distress and unequal access to cardio-oncology services (specialised medical services that focus on the heart health of cancer patients) as important actionable targets for improving cardiovascular outcomes, such as the development of heart attacks, strokes and heart failure, in cancer survivors.
This research underscores the significant impact of SDOH on mortality among cancer survivors and identifies the key domains of SDOH that affect their well-being. These insights can guide the development of targeted interventions and support systems tailored to address these domains and enhance the overall well-being of cancer survivors.
For more details, please refer to the following publication generated from the research project:
‘Associations between social determinants of health and cardiovascular and cancer mortality in cancer survivors: a prospective cohort study’, European Journal of Preventive Cardiology.
[1] Ferrari AJ, Santomauro DF, Aali A, Abate YH, Abbafati C, Abbastabar H, et al. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systema. Lancet 2024;403:2133–2161.
[2] Mensah GA, Fuster V, Murray CJL, Roth GA. Global burden of cardiovascular diseases and risks, 1990–2022. J Am Coll Cardiol 2023;82:2350–2473.
