Key result
Low positive social determinants linked to ~77% higher CV mortality in high allostatic load cancer patients.
Why the study?
Does low exposure to positive social determinants of health increase the risk of cardiovascular death in adults with and without a cancer history?
Cohort (n=22,775)
Yes
Does low exposure to positive social determinants of health increase the risk of cardiovascular death in adults with and without a cancer history?
Hazard Ratio: 1.38 (95% CI 1.22–1.56)
Low exposure to positive social determinants of health significantly increases the risk of cardiovascular mortality, particularly among adults with a history of cancer, suggesting social factors may supersede biological changes from chronic stress.
May support social determinant screening in high allostatic load adults; leaves open whether interventions reduce cardiovascular mortality in cancer survivors.
Background Allostatic load (AL) is a measure of the biological "wear and tear" or cumulative physiological effects of chronic stress exposure. High AL is associated with an increased risk of cardiovascular death (CVD). Methods We conducted a retrospective cohort analysis of the National Health and Nutrition Examination Survey (1999 - 2010) linked with the National Death Index through 2019. AL was calculated using a nine-point score assessing a combination of physiologic measurements. Positive social determinants of health (PSDOH) was calculated using a seven-point score assessing a combination of socioeconomic exposures. We fit age, race, and sex-adjusted Fine & Gray models to calculate sub-distribution hazard ratios (SHR) of CVD among adults exposed to high versus low levels of PSDOH, stratified by high and low AL status. Results Among 22,775 participants, 1939 had a cancer history. In the full cohort, low PSDOH was associated with 38% increased risk of CVD among high AL adults (SHR: 1.38, 95% CI: 1.22 - 1.56) and 57% increased risk among low AL adults (SHR: 1.57, 95% CI: 1.32 - 1.87). Among adults without a cancer history, low PSDOH was associated with 36% increased risk of CVD among high AL adults (SHR: 1.36, 95% CI: 1.19 – 1.55) and 59% increased risk among low AL adults (SHR: 1.59, 95% CI: 1.32 – 1.92). Among adults with a cancer history, low PSDOH was associated with 77% increased risk of CVD among high AL adults (SHR: 1.77, 95% CI: 1.32 – 2.37) and 73% increased risk among low AL adults (SHR: 1.73, 95% CI: 1.02 – 2.94). Conclusions Low PSDOH exposure amplified the association between AL and CVD in all cohorts, with the highest risk increases seen among adults with a cancer history. This suggests that the impact of social determinants supersedes biological changes from chronic stress alone with respect to CVD.
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Bhave et al. (2026) conducted a cohort in Cardiovascular mortality risk in cancer and non-cancer patients (n=22,775). Low positive social determinants of health (PSDOH) vs. High levels of PSDOH was evaluated on Cardiovascular death (CVD) among high allostatic load adults in the full cohort (SHR 1.38, 95% CI 1.22-1.56). Low positive social determinants of health increased cardiovascular death risk, with the highest risk seen in cancer patients with high allostatic load (SHR 1.77; 95% CI 1.32-2.37).
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