Socioeconomic position and its effect on cardiovascular outcomes and mortality In patients with prostate cancer

Background Socioeconomic position (SEP) is a fundamental social determinant of health (SDOH) contributing to observed disparities in cancer and cardiovascular (CV) care among individuals with prostate cancer (PC). Understanding the influence of SEP on CV health is essential for addressing outcome inequities within this population. Methods We conducted a retrospective study utilizing SEER-Medicare to evaluate CV outcomes in patients ≥65 years with PC from 2012 to 2017. We studied the impact of SEP on Cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm) and all-cause mortality. CVE, CVm, PCsm were analyzed using competing risk models and all-cause mortality with Cox proportional hazards models. A subgroup analysis was performed in Non-Hispanic Black and Non-Hispanic White individuals. Results We included 141,242 patients of whom 76,844 were in high SEP areas (45.6%) and 64,398 in low SEP ones (54.4%). Both groups had a mean age of 72 years; patients in low SEP areas were 67.5% Non-Hispanic White, 34.4% having diabetes, 73.3% hypertension, and 67.7% dyslipidemia versus high SEP group with 85.6% Non-Hispanic White, 30.4% diabetes, 69.9% hypertension, and 70.7% dyslipidemia. Patients in low SEP areas had higher risks of CVm (subdistribution hazard ratio [sHR] 1.18, 95% CI 1.12-1.25), PCsm (sHR: 1.12, 95% CI 1.06-1.17), CVE (sHR 1.07, 95% CI 1.04-1.09), and all-cause mortality (HR 1.16, 95% CI 1.13-1.20). Accentuated results were shown in the Non-Hispanic Black subgroup. Conclusion Adverse SEP plays a significant role in shaping outcomes among older patients with PC, contributing to elevated risks of adverse CV and survival outcomes.