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September 6, 2026Journal of Cancer SurvivorshipOpen Access

Higher poverty-to-income ratio linked to ~67% lower CVD odds in female breast cancer survivors.

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Why the study?

Cardiovascular disease remains a leading cause of poor outcomes among breast cancer survivors, and social determinants of health like economic deprivation compound this vulnerability.

Does higher poverty-to-income ratio reduce the odds of cardiovascular disease in female breast cancer survivors?

Population

2745 female breast cancer survivors from the 2019 to 2022 NHIS

Comparison

Associations between poverty-to-income ratio and self-reported CVD across subgroups

Design

Cross-sectional survey study using IPTW-adjusted logistic models

Key result

Higher poverty-to-income ratio (PIR ≥ 4) was associated with a 67% lower odds of cardiovascular disease (OR 0.33) compared to the lowest income tier (PIR ≤ 1.49) among female breast cancer survivors.

Authors

RWRobina Josiah WillockDPDaniel ParksSNSamah Nabi

Discussion

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Overview

May inform income-based CVD risk stratification in breast cancer survivors; leaves open causal effects and intervention targets.

Key Points

  • To examine the association between the poverty-to-income ratio and cardiovascular disease prevalence among female breast cancer survivors across diverse racial and age groups.
  • Analyzed cross-sectional National Health Interview Survey (NHIS) data from 2019 to 2022 among female breast cancer survivors (N=2745).
  • Estimated inverse probability of treatment weighting (IPTW)-adjusted logistic regression models to assess associations between poverty-to-income ratio (PIR) and self-reported CVD, evaluating interactions with race, age, survivorship duration, and delayed medical care.
  • Cardiovascular protection from higher PIR was significantly modified by race/ethnicity (p < 0.0001), lowering CVD odds by 92% in Black survivors and 68% in White survivors, with no significant association in Asian survivors.
  • Protection from higher PIR peaked among survivors younger than 65 years and diminished progressively through age ≥ 85 years (p = 0.017).
  • Interaction terms were non-significant for years of survivorship (p > 0.05) and approached statistical significance for delayed care-seeking.

Study Design

Type

Cross-Sectional (n=2,553)

Structured PICO

Does higher poverty-to-income ratio reduce the odds of cardiovascular disease in female breast cancer survivors?

P
Population
2,553 female breast cancer survivors from a nationally representative US survey (NHIS 2019-2022) evaluated for the association between economic deprivation and self-reported cardiovascular disease.
E
Exposure
Higher poverty-to-income ratio (PIR) categories (PIR 1.50-2.49, 2.50-3.99, and >= 4)
C
Comparator
Lowest poverty-to-income ratio category (PIR <= 1.49)
O
Outcome
Self-reported physician-confirmed positive diagnosis of one or more of three major CVD conditions (non-fatal stroke, nonfatal myocardial infarction, and/or coronary artery disease)composite

Main Result

Odds Ratio: 0.33 (95% CI 0.24–0.44)

p-value: p=<0.0001

Higher income (poverty-to-income ratio) is a robust predictor of lower comorbid cardiovascular disease in female breast cancer survivors, with the strongest protective effects observed among younger and Black survivors.

Limitations

  • Relatively small number of survivors in some variable cohorts
  • Predominantly non-Hispanic White sample limits generalizability to more diverse populations
  • Health history data derived from self-report, introducing potential recall bias
  • Cross-sectional design precludes assessment of temporality or causality
  • Inability to control for breast cancer stage and treatment, potentially introducing survivorship bias

Cite This Study

Willock et al. (2026) conducted a cross-sectional in Female breast cancer survivors (n=2,553). Higher poverty-to-income ratio (PIR ≥ 4) vs. Lower poverty-to-income ratio (PIR ≤ 1.49) was evaluated on Self-reported cardiovascular disease (CVD) diagnosis (composite of non-fatal stroke, nonfatal myocardial infarction, and/or coronary artery disease) (OR 0.33, 95% CI 0.24-0.44, p=<0.0001). Higher poverty-to-income ratio (PIR ≥ 4) was associated with a 67% lower odds of cardiovascular disease (OR 0.33) compared to the lowest income tier (PIR ≤ 1.49) among female breast cancer survivors.

synapsesocial.com/papers/6a9d1e6328139818eab2131fhttps://doi.org/10.1007/s11764-026-02112-3
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