Integration of individual‐level social determinants of health and associations with cardiovascular risk factors in breast and prostate cancer

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Breast cancer or prostate cancer initiating potentially cardiotoxic cancer therapy (n=388). Intervention: Integrated individual-level social determinants of health (SDOH) dimensions (per 1-IQR increase in dimension 1 score) vs. Census tract-level Social Vulnerability Index (SVI). Primary outcome: Longitudinal changes in moderate-to-vigorous physical activity (Godin MVPA score) over 12 months in breast cancer per 1-IQR increase in SDOH dimension 1 score (MD -2.5, 95% CI -4.8 to -0.3).

Q: What does this research mean for the field?

Higher adverse individual-level social determinants of health scores are significantly associated with reduced moderate-to-vigorous physical activity over 12 months in patients with breast and prostate cancer initiating cardiotoxic therapy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Wonyoung Jung; Gary Hettinger; Vivek Narayan; Lin Mei; Samuel Takvorian; Yehoda M. Martei; Amy Clark; Anran Huang; Kellie McDermott; Amanda M. Smith; Congying Xia; Kyunga Ko; Javier Sierra Pagan; Daniel Koropeckyj-Cox; Kelly Getz; Carmen E. Guerra; Oluwadamilola M. Fayanju; Sanchit Kumar; Kirsten M. M. Beyer; Tiffany Powell‐Wiley; Clyde Yancy; Yong‐Moon Mark Park; Bonnie Ky

doi:10.1002/cncr.70674

Key result

Adverse individual SDOH linked to ~2.5-point lower physical activity in cancer patients.

MD -2.5
95% CI -4.8 to -0.3
n=388

Figures

Why the study?

Strategies to integrate multiple individual-level social determinants of health (SDOH) remain limited in cardio-oncology.

Does integrating multiple individual-level social determinants of health via dimensionality reduction identify longitudinal associations with cardiovascular risk factors (blood pressure, BMI, physical activity) over 12 months in patients with breast or prostate cancer initiating potentially cardiotoxic therapy compared with the area-level Social Vulnerability Index?

Key Points

To integrate multiple individual-level social determinants of health using dimensionality reduction and assess their longitudinal associations with cardiovascular risk factors during cancer therapy.
Two prospective longitudinal cohorts enrolled 193 women with breast cancer (NCT05078190) and 195 men with prostate cancer (NCT05096338) initiating potentially cardiotoxic therapy across six locations.
Assessed 16 individual-level social determinants of health (20 effective variables) at baseline and applied factorial analysis of mixed data to derive orthogonal dimensions.
Evaluated 12-month changes in blood pressure, body mass index, and moderate-to-vigorous physical activity using generalized estimating equations, alongside the neighborhood-level social vulnerability index.
Six orthogonal dimensions explained nearly 50% of the total variability in social determinants of health within each cohort.
In breast cancer, each 1-interquartile range increase in dimension 1 (food insecurity and financial toxicity) was associated with a 0.3-kg/m 2 higher body mass index (95% CI, 0.02–0.5 kg/m 2 ) and a 2.5-point lower moderate-to-vigorous physical activity score (95% CI, −4.8, −0.3).
In prostate cancer, each 1-interquartile range increase in dimension 1 (education, occupational prestige, income, employment, and health literacy) was associated with a 2.6-point lower moderate-to-vigorous physical activity score (95% CI, −4.6, −0.6), whereas the social vulnerability index showed no significant association with risk factor changes.

Study Design

Type

Cohort (n=388)

Multicenter

Yes

Structured PICO

Does integrating multiple individual-level social determinants of health via dimensionality reduction identify longitudinal associations with cardiovascular risk factors (blood pressure, BMI, physical activity) over 12 months in patients with breast or prostate cancer initiating potentially cardiotoxic therapy compared with the area-level Social Vulnerability Index?

P

Population

388 adults (193 women with breast cancer, median age 50; 195 men with prostate cancer, median age 69) initiating potentially cardiotoxic cancer therapy across six US cancer center locations, followed for 12 months.

E

Exposure

Baseline comprehensive assessment of 16 individual-level social determinants of health (SDOH; 20 effective variables) before initiating potentially cardiotoxic cancer therapy, integrated into 6 orthogonal composite dimensions via factorial analysis of mixed data (FAMD).

C

Comparator

Area-level Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention at the census-tract level (used as a comparator measure of structural SDOH).

O

Outcome

Longitudinal changes in cardiovascular risk factors (CVRFs) over 12 months following initiation of potentially cardiotoxic cancer therapy, specifically systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and moderate-to-vigorous physical activity (MVPA, measured via Godin Leisure-Time Physical Activity Questionnaire).surrogate

Main Result

Mean Difference: -2.5 (95% CI -4.8–-0.3)

Data-driven dimensionality reduction of individual-level social determinants of health identifies specific social exposures (such as food insecurity, financial toxicity, and socioeconomic status) associated with worsening BMI and lower physical activity over 12 months in breast and prostate cancer patients receiving cardiotoxic therapy, whereas the area-level Social Vulnerability Index showed no significant association.

Limitations

SDOH measures were assessed only at baseline using a survey questionnaire, precluding evaluation of temporal changes and introducing potential measurement error
Modest sample size from a single health system, potentially limiting generalizability
Relatively young age of the breast cancer cohort and small number of Hispanic participants
Lack of external validation
12-month follow-up duration limits assessment of hard cardiac events and longer-term associations
Unmeasured confounding factors such as diet and inflammatory or stress-related biomarkers

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Implication

Individual-level SDOH dimensions may flag cancer patients at risk for activity decline; leaves open superiority over area-level SVI for risk stratification.

Abstract

Background Strategies to integrate multiple individual‐level social determinants of health (SDOH) remain limited in cardio‐oncology. Methods Across two longitudinal prospective cohorts of 193 women with breast cancer (ClinicalTrials.gov identifier NCT05078190) and 195 men with prostate cancer (ClinicalTrials.gov identifier NCT05096338) who were initiating potentially cardiotoxic cancer therapy, the authors comprehensively assessed 16 individual‐level SDOH (20 effective variables) before treatment initiation. For each cohort, a data‐driven approach using dimensionality reduction by means of factorial analysis of mixed data was conducted. Longitudinal associations between each dimension and cardiovascular risk factors (CVRFs; blood pressure, body mass index, and moderate‐to‐vigorous physical activity [MVPA]) over 12 months were estimated using generalized estimating equations scaled to a 1‐interquartile range increase in the dimension score. As a comparator with individual SDOH measures, associations between CVRFs and the social vulnerability index were assessed. Results In each cohort, six orthogonal dimensions explained nearly 50% of the total variability in SDOH. In breast cancer, dimension 1 (16.4% variability) reflected food insecurity and financial toxicity. Each 1‐interquartile range increase in the dimension 1 score was associated with a 0.3‐kg/m 2 higher body mass index (95% confidence interval [CI], 0.02–0.5 kg/m 2 ) and a 2.5‐point lower MVPA score (95% CI, −4.8, −0.3). In prostate cancer, dimension 1 (16.0% variability) reflected education, occupational prestige, income, employment, and health literacy. Each 1‐interquartile range increase in the dimension 1 score was associated with a 2.6‐point lower MVPA score (95% CI, −4.6, −0.6). The social vulnerability index was not significantly associated with longitudinal changes in CVRFs. Conclusions This work supports a data‐driven approach to integrate multiple individual‐level SDOH measures to inform the associations between multilevel SDOH measures and cardiovascular risk in cancer.

Discussion

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Cite This Study

Jung et al. (2026) conducted a cohort in Breast cancer or prostate cancer initiating potentially cardiotoxic cancer therapy (n=388). Integrated individual-level social determinants of health (SDOH) dimensions (per 1-IQR increase in dimension 1 score) vs. Census tract-level Social Vulnerability Index (SVI) was evaluated on Longitudinal changes in moderate-to-vigorous physical activity (Godin MVPA score) over 12 months in breast cancer per 1-IQR increase in SDOH dimension 1 score (MD -2.5, 95% CI -4.8 to -0.3). Higher adverse individual-level SDOH dimension 1 scores were associated with lower moderate-to-vigorous physical activity in breast and prostate cancer over 12 months.

synapsesocial.com/papers/6af9ebcdd393cbc380a0504e https://doi.org/10.1002/cncr.70674

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Integration of individual‐level social determinants of health and associations with cardiovascular risk factors in breast and prostate cancer

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Integration of individual‐level social determinants of health and associations with cardiovascular risk factors in breast and prostate cancer

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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