心血管疾病（CVD）是男性前列腺癌发病和死亡的一个重要原因；然而，关于 CVD 结果的种族差异的数据有限。我们根据自我认定的种族以及健康的结构性社会决定因素在调节前列腺癌患者差异中的作用，量化了 CVD 的差异。一项针对 3,543 名前列腺癌的回顾性队列研究对 2008 年至 2021 年间在四级多站点医疗保健系统接受全身雄激素剥夺疗法 (ADT) 治疗的患者进行了研究。使用特定原因比例风险评估自我报告的种族（黑人与白人）与 ADT 开始后发生的主要不良心血管事件 (MACE) 之间的多变量调整关联。中介分析确定了特定主题和整体社会脆弱性指数 (SVI) 在解释 CVD 结果中的种族差异方面的作用。黑人种族与 MACE 危险增加相关（HR：1.38；95% CI：1.16-1.65；P < 0.001)。心力衰竭（HR：1.79；95% CI：1.32-2.43）、脑血管疾病（HR：1.98；95% CI：1.37-2.87）和外周动脉疾病（HR：1.76；95% CI：1.37-2.87）与黑人种族的相关性最强。 95% CI：1.26-2.45）（P < 0.001）。 SVI，特别是社会经济地位主题，介导了黑人和白人患者之间 98% 的 MACE 风险差异。与白人患者相比，黑人患者在全身 ADT 后出现不良 CVD 结局的可能性明显更大。这些差异是由人口普查区 SVI 捕获的社会经济地位和其他健康结构性决定因素造成的。我们的研究结果激发了以解决社会经济脆弱性为重点的多层次干预措施。© 2024 由爱思唯尔代表美国心脏病学会基金会发布。

Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in men with prostate cancer; however, data on racial disparities in CVD outcomes are limited.We quantified the disparities in CVD according to self-identified race and the role of the structural social determinants of health in mediating disparities in prostate cancer patients.A retrospective cohort study of 3,543 prostate cancer patients treated with systemic androgen deprivation therapy (ADT) between 2008 and 2021 at a quaternary, multisite health care system was performed. The multivariable adjusted association between self-reported race (Black vs White) and incident major adverse cardiovascular events (MACE) after ADT initiation was evaluated using cause-specific proportional hazards. Mediation analysis determined the role of theme-specific and overall social vulnerability index (SVI) in explaining the racial disparities in CVD outcomes.Black race was associated with an increased hazard of MACE (HR: 1.38; 95% CI: 1.16-1.65; P < 0.001). The association with Black race was strongest for incident heart failure (HR: 1.79; 95% CI: 1.32-2.43), cerebrovascular disease (HR: 1.98; 95% CI: 1.37-2.87), and peripheral artery disease (HR: 1.76; 95% CI: 1.26-2.45) (P < 0.001). SVI, specifically the socioeconomic status theme, mediated 98% of the disparity in MACE risk between Black and White patients.Black patients are significantly more likely to experience adverse CVD outcomes after systemic ADT compared with their White counterparts. These disparities are mediated by socioeconomic status and other structural determinants of health as captured by census tract SVI. Our findings motivate multilevel interventions focused on addressing socioeconomic vulnerability.© 2024 Published by Elsevier on behalf of the American College of Cardiology Foundation.