Multi-level drivers of cardiovascular health during cancer survivorship

Among individuals who survive ≥5 years from a cancer diagnosis, cardiovascular disease (CVD) is the leading cause of death. Indeed, adults with cancer have more than twice the risk of poor CVD outcomes as adults without cancer. This difference is partially due to the incidence of cardiotoxic effects from cancer therapies, but we hypothesize that upstream factors (e.g., area-level indicators of social context and individual socio-economic position) are also responsible for CVD outcomes in cancer survivors. We have shown that having ≥1 adverse socio-economic indicators increases an individual’s risk of coronary heart disease, stroke, and heart failure outside of cancer. However, underlying mechanisms of how upstream factors may lead to worse CVD outcomes in cancer survivors are not well understood. Area-level factors such as high school completion rates, unemployment rates, and public health infrastructure have policy implications and understanding their downstream influences on CVD can point the way to solutions to improve CVD health for all Americans. The objective of this proposal is to determine the role of area-level social context and individual socio-economic position on CVD outcomes among a community-based cohort of 8,000 adults with cancer. We seek to leverage a novel link between data from the 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 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 social context 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 multi-level socio-economic indicators and CVD outcomes; 2) the role of cancer biologic, behavioral, and psychosocial factors in the relationship between multi-level socio-economic indicators and CVD; and 3) the role of cancer and non-cancer health service use in the relationship between multi-level socio-economic indicators and CVD. Our long-term goal is to develop strategies to improve CVD health among all cancer survivors. We have assembled a multi-disciplinary team of experts in CVD and cancer epidemiology, health services research, cardiology, oncology, and biostatistics. Together, we will generate evidence to inform and develop interventions to support CVD health during cancer survivorship.