Income, race, and cardiovascular disease in female breast cancer survivors: evidence of moderated socioeconomic protection in the National Health Interview Survey (NHIS) 2019-2022.

UNLABELLED: Cardiovascular disease (CVD) remains a leading cause of poor outcomes among breast cancer survivors. Treatment contributes to both acute and long-term CVD risk, but social determinants of health (SDoH), like economic deprivation, also compound vulnerability. This study examined the associations between poverty-to-income ratio (PIR) and self-reported CVD in a national sample of breast cancer survivors.

METHODS

Using National Health Interview Survey (NHIS) data from 2019 to 2022, we examined sociodemographic characteristics, health behaviors, and comorbidities in a sample of 2745 female breast cancer survivors. We tested IPTW-adjusted logistic models for associations between PIR and CVD prevalence and interactions by race, age, years of survivorship, and delayed medical care.

RESULTS

Higher income did not protect survivors equally. The protection of higher PIR was significantly modified by race/ethnicity (p < 0.0001). Higher PIR reduced the odds of CVD 92% among Black survivors, compared to 68% among White survivors, with no significant association among Asian survivors. The protection of higher PIR was greatest among survivors aged < 65 years and lessened progressively up to ≥ 85 years (p = 0.017). The overall interaction terms were non-significant (p > 0.05) for years of breast cancer survivorship and approached significance for delayed care-seeking.

CONCLUSIONS

PIR emerged as a robust predictor of comorbid CVD with strongest protection among younger, racial/ethnic minority, and early-survivorship subgroups.

IMPLICATIONS FOR CANCER SURVIVORS: Clinical CVD risk models in breast cancer remain underspecified when measures of economic status are excluded. These findings support extending clinical guidance for CVD prevention beyond the current 5-year threshold and integrating economic screening into survivorship care.