Atherosclerotic Cardiovascular Disease and Cancer Linked With Social Disadvantage

Cumulative social disadvantage in adults in the United States (US) is associated with increased risk for atherosclerotic cardiovascular disease (ASCVD), with or without cancer, according to study results presented at the American College of Cardiology (ACC) 2023 conference, held from March 4 to 6, 2023, in New Orleans, Louisiana.

Investigators sought to evaluate the burden of cumulative social disadvantage by cancer and ASCVD status, including co-occurring ASCVD and cancer.

They conducted a retrospective study using data from the 2013 to 2015 National Health Interview Survey. They aggregated deprivations across 6 social determinants of health (SDOH) domains (economic stability, education, food security, health care system, housing, and community/social context) to create an index of social disadvantage. Respondents were grouped by index quartiles (SDOH-Q1 to Q4). Greater social disadvantage was indicated with higher quartiles.

Overall, the study included 104,926 adults (mean age, 47 years), of whom 85% reported neither condition, 7% reported cancer only, 6% reported ASCVD only, and 2% reported both conditions. They found the ASCVD-only group had the highest proportion of all individuals in SDOH-Q4 (26.8%), followed by patients without either condition (22.2%), patients with both conditions (18.7%), and patients with cancer only (14.2%).

There were 40% higher odds for individuals with ASCVD only being in SDOH-Q4 (odds ratio [OR], 1.38; 95% CI, 1.30-1.47) than the lower disadvantage quartiles. Individuals with comorbid cancer and ASCVD had 20% higher odds of being in SDOH-Q4 (OR, 1.19; 95% CI, 1.07-1.32) than lower disadvantage quartiles. There were similar associations in older-age and younger groups. Individuals aged 18 to 64 years with comorbid cancer and ASCVD had 90% higher odds of being in SDOH-Q4 (OR, 1.89; 95% CI, 1.53-2.34).

“ASCVD, with or without cancer, is consistently associated with cumulative social disadvantage in US adults,” the investigators wrote. “Efforts to narrow inequities in ASCVD and cancer burden require due attention to addressing SDOH.”