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Review
. 2024 May 7;6(3):331-346.
doi: 10.1016/j.jaccao.2024.02.009. eCollection 2024 Jun.

Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review

Foster Osei Baah  1   2 , Sonal Sharda  1 , Kimberly Davidow  3 , Sadhana Jackson  4   5 , Daphney Kernizan  6   7 , Joshua A Jacobs  8 , Yvonne Baumer  1 , Corinna L Schultz  3 , Carissa M Baker-Smith  9 , Tiffany M Powell-Wiley  1   10
Affiliations
Review

Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review

Foster Osei Baah et al. JACC CardioOncol. .

Abstract

Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.

Keywords: cardio-oncology; cardiology; care delivery model; disparities; epidemiology; lifestyle risk factors; signaling pathways; social determinants of health.

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Conflict of interest statement

The Powell-Wiley Lab is funded by the Division of Intramural Research of the National, Heart, Lung, and Blood Institute of the National Institutes of Health and the Intramural Research Program of the National Institute on Minority Health and Health Disparities. This research was made possible through the National Institutes of Health Medical Research Scholars Program, a public-private partnership supported jointly by the National Institutes of Health and generous contributions to the Foundation for the National Institutes of Health from the Doris Duke Charitable Foundation, Genentech, the American Association for Dental Research, the Colgate-Palmolive Company, Elsevier, alumni of student research programs, and other individual supporters via contributions to the Foundation for the National Institutes of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
The Social Determinants of Cardio-Oncologic Disparities Disparities in cardio-oncologic outcomes are shaped by the trickle-down effects of systemic-, social-, and community-level factors at an individual’s social position. Marginalized individuals who experience the intersectional effects of multiple negative social determinants of health may also experience a double burden of poor cardiovascular disease outcomes and cancer mortality.
Figure 2
Figure 2
Commonalities in Signaling Pathways Between SDOH and Cancer Therapeutics in CVD All pathways mentioned in this figure, but especially the ones common for social determinants of health (SDOH) and cancer therapeutics, have been shown to be crucial for cardiovascular disease (CVD) development along with progression. BCR-ABL1 = breakpoint cluster region-Abelson leukemia gene 1; CHIP = clonal hematopoiesis of indeterminate potential; DNMT = DNA methyltransferase; HER2 = human epidermal growth factor receptor 2; IL = interleukin; MAPK = mitogen-activated protein kinase; mtDNAcn = mitochondrial DNA copy number; NF-κB = nuclear factor kappa-light-chain-enhancer of activated B cells; PPM1D = protein phosphatase, Mg2+/Mn2+ dependent 1D; ROS = reactive oxygen species; TET2 = ten-eleven translocation 2; TOP2β = topoisomerase; TNF = tumor necrosis factor; TP53 = tumor protein 53; VEGF = vascular endothelial growth factor.
Central Illustration
Central Illustration
Social Determinants of Health and Cardio-Oncology These social determinants of health (SDOH) domains have been shown to be integral to the development and progression of cardio-oncologic outcomes. Moreover, clonal hematopoiesis, as well as epigenetic (related to mitochondrial DNA copy number and DNA alterations) and cell signaling mechanistic pathways, which influence catecholamines and inflammatory cytokines, further link SDOH to cardio-oncology. It is imperative to consider the integration of SDOH into targeted interventions that encourage health equity within the field of cardio-oncology. The rightward arrow indicates the influence of adverse SDOH on biological pathways. The upward arrow indicates the integration of SDOH into cardio-oncologic care to impact cardio-oncology outcomes. CHIP = clonal hematopoiesis of indeterminate potential; ROS = reactive oxygen species.
See this image and copyright information in PMC

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