Key result
Adverse social determinants of health are linked to higher CVD incidence and mortality in breast cancer survivors.
Why the study?
Breast cancer survivors face an increased risk of CVD, but few studies have evaluated how social determinants of health are associated with CVD disparities in this group, and no systematic review had addressed their multilevel influences.
Do social determinants of health (SDoHs) impact cardiovascular disease-related outcomes in breast cancer survivors?
Systematic Review
Do social determinants of health (SDoHs) impact cardiovascular disease-related outcomes in breast cancer survivors?
Social determinants of health, particularly Black race, lower neighborhood SES, and rural residence, are significantly associated with worse cardiovascular outcomes in breast cancer survivors, highlighting the need for multilevel interventions.
May warrant SDoH-informed CVD surveillance in breast cancer survivors; extends observational evidence but leaves intervention effects open.
BACKGROUND: Breast cancer is the most commonly diagnosed malignancy worldwide. Breast cancer survivors face an increased risk of cardiovascular disease (CVD), a leading cause of death in this group. Social determinants of health (SDoHs), operationalized as economic, environmental, and psychosocial factors, play an important role in CVD disparities. However, few studies have examined how SDoHs are associated with CVD disparities in this population, and no systematic review has addressed their multilevel influences. METHODS: This systematic review summarizes the current evidence on the relationships between SDoHs at different levels and CVD disparities among breast cancer survivors. Using the 2024 American College of Cardiology/American Heart Association framework, SDoHs were categorized at the individual, interpersonal, or community levels. Studies published in peer-reviewed journals between January 1, 2010, and November 30, 2025, were identified through searching electronic databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsycINFO) and citations. RESULTS: Of 6550 unique records, 37 articles that addressed the impact of SDoHs on CVD outcomes were selected. Most (n=31) were conducted in the United States and used retrospective designs (n=29). Most (n=30) focused on individual-level SDoHs such as race, income, or education; 2 on interpersonal-level SDoHs (ie, psychosocial stress); and 13 on community-level SDoHs, including neighborhood socioeconomic status and residential area. Black race, lower neighborhood socioeconomic status, and rural residence were associated with a higher incidence of CVD and increased cardiovascular death. CONCLUSIONS: This review highlights the urgent need to address SDoHs and emphasizes the importance of multilevel interventions to reduce CVD disparities among breast cancer survivors.
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Lee et al. (2026) conducted a systematic review in Breast cancer survivors at risk for cardiovascular disease. Adverse social determinants of health (SDoHs) vs. Favorable SDoHs (e.g., non-Hispanic White race, higher SES, urban residence) was evaluated on Cardiovascular disease outcomes (CVD death, CVD incidence, cardiotoxicity). Black race, lower neighborhood socioeconomic status, and rural residence were associated with a higher incidence of cardiovascular disease and increased cardiovascular death among breast cancer survivors.
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