Social Determinants of Health and Cardiovascular Disease-Related Outcome Disparities Among Breast Cancer Survivors: A Systematic Review

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: No pooled effect size reported; narrative synthesis identifies consistent associations: Black race, lower neighbourhood socioeconomic status, and rural residence associated with higher CVD incidence and increased cardiovascular death

• Primary Outcome: CVD incidence and cardiovascular mortality among breast cancer survivors in relation to SDoH exposures

• Nnt Or Sensitivity: Not calculable from this review; individual study-level hazard ratios, odds ratios, or risk ratios are not synthesised. Future meta-analysis would be required to derive clinically actionable effect estimates.

• Confidence Interval: Not reported (narrative review without meta-analysis)

Clinical Application

Implementation of SDoH-informed cardiovascular risk assessment in breast cancer survivorship clinics is feasible using validated screening tools (e.g., PRAPARE, AHC Health-Related Social Needs Screening Tool). However, the evidence base for specific interventions to reduce SDoH-mediated CVD disparities remains nascent. Multidisciplinary cardio-oncology teams incorporating social workers and community health workers would be required for meaningful implementation. In the Australian context, this review has moderate relevance. Breast cancer is the most commonly diagnosed cancer in Australian women (Australian Institute of Health and Welfare data). Aboriginal and Torres Strait Islander women face documented disparities in both breast cancer outcomes and cardiovascular disease burden, paralleling the Black-White disparities identified in this US-centric review. Rural and remote Australians similarly face access barriers to both oncology and cardiology services. The RACGP's 2023 guidelines on preventive care and the National Aboriginal and Torres Strait Islander Health Plan both emphasise SDoH-informed care. PBS-listed cardioprotective medications (e.g., ACE inhibitors, beta-blockers for anthracycline-related cardiotoxicity) are accessible, but equitable uptake across SDoH strata requires active monitoring. TGA-approved cardiotoxic breast cancer therapies (anthracyclines, trastuzumab, CDK4/6 inhibitors) are widely used in Australia, making SDoH-stratified cardiac surveillance clinically urgent. The findings support advocacy for Medicare-funded SDoH screening in survivorship care pathways. Female breast cancer survivors, particularly those from racially minoritised groups (especially Black women), those residing in low socioeconomic status neighbourhoods, and those in rural or geographically remote areas. Clinicians managing survivorship care should consider SDoH screening as part of cardiovascular risk stratification in this population.

Abstract

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.

References

1. 1.Lee, M., Goldenberg, S. M., Dávila-Conn, V., & Parada, H. (2026). Social determinants of health and cardiovascular disease-related outcome disparities among breast cancer survivors: A systematic review. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.046549