Social determinants of health in cancer survivors and the risk of cardiovascular events

Publication Information

Title: Social determinants of health in cancer survivors and the risk of cardiovascular events

Author(s): Shunxuan Yan, Yingsi Hu, Weiwen Su, Shangxi Xie, Jialing Lin, Jinfeng Ding, Jinqiu Yuan, Jiali Feng, Qiangsheng He, Da-Lin Lu, Yanhui Gao, Xiwen Simon Qin

‌Journal Name, Year, Volume(Issue): Page range: European Journal of Preventive Cardiology, Volume 33, Issue 4, March 2026, Pages 557–565

DOI: 10.1093/eurjpc/zwaf633

Abstract:

Aims: The impact of social determinants of health (SDoH) on cardiovascular disease (CVD) risk in cancer survivors remains unclear. We examined the association between SDoH and subsequent CVD risk among cancer survivors.

Methods and results: This retrospective cohort study included 18 992 cancer survivors and 75 968 propensity score matched non-cancer controls from the UK Biobank. A composite SDoH score was generated using 17 components across 5 domains, classifying participants into favourable, medium, and unfavourable SDoH groups. Cox models were used to assess associations between SDoH and incident CVD, including ischaemic heart disease (IHD), heart failure (HF), stroke, and CVD mortality. Compared with cancer survivors with favourable SDoH, those with medium and unfavourable SDoH had higher CVD risks: hazard ratio (HR) 1.17 (95% CI: 1.09-1.27) and HR 1.32 (95% CI: 1.23-1.43), respectively. Unfavourable SDoH was also associated with increased risk of IHD (HR: 1.31; 95% CI: 1.15-1.49), HF (HR: 1.58; 95% CI: 1.30-1.92), stroke (HR: 1.47; 95% CI: 1.18-1.84), and CVD mortality (HR: 1.54; 95% CI: 1.25-1.90). Cancer survivors with favourable SDoH had overall CVD risks similar to matched non-cancer controls (HR: 1.07; 95% CI: 1.00-1.13). In joint analysis, cancer survivors with favourable SDoH had a higher risk (HR: 1.22; 95% CI, 1.15-1.28) than their non-cancer counterparts.

Conclusion: Among cancer survivors, unfavourable SDoH was associated with elevated CVD risk, whereas favourable SDoH attenuated this risk to levels comparable with non-cancer population. That may partly reflect the increased risk observed among non-cancer with unfavourable SDoH. Targeted interventions and policy measures addressing social determinants are needed to mitigate cardiovascular disparities in cancer survivorship.

Keywords: Cancer survivors; Cardiovascular disease; Health inequities; Social determinants of health.

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