Socioeconomic disparities in cardio-oncology breast cancer patients from a single institution.

Abstract

e24018 Background: Breast cancer is associated with significant cardiotoxicity, and underserved populations experience disproportionately higher rates of both breast cancer and cardiovascular (CV) disease. In the growing field of cardio-oncology, there is an increasing need to explore socioeconomic (SE) disparities in CV outcomes among breast cancer patients. Existing studies use zip code median income as a surrogate for financial status, but census tract-based analyses may provide higher accuracy. Methods: We conducted a single-center retrospective chart review of 92 breast cancer patients referred to our cardio-oncology program from January 2022 to January 2024. Descriptive statistics assessed census tract 2023 median income quintile, demographic factors, baseline cardiac comorbidities, cancer characteristics and treatments, and CV outcomes. Cardiotoxicity was defined as development of new or worsened heart failure, myocardial infarction, or atrial fibrillation during or after therapy. A multivariable logistic regression model evaluated predictors of cardiotoxicity, adjusting for age at diagnosis, BMI, payer type, anthracycline therapy, and anti-HER2 therapy. Results: After excluding patients with missing data, 80 remained for analysis. Prior to cancer diagnosis, 60% had hypertension and 15% had heart failure. 20% had stage III at diagnosis and 14% had stage IV. 70% were hormone-receptor positive and 30% were HER2 positive. 45% received anti-HER2 therapy and 30% received anthracyclines. Median EF change was –10 and 49% developed cardiotoxicity. When stratified by income quintile, black race (p<0.01), pre-existing hypertension (p<0.01), and clinical stage III at diagnosis (p<0.05) varied across groups. In the logistic regression, income quintiles Q2 (p=0.045) and Q3 (p=0.016) were associated with lower odds of cardiotoxicity compared to Q1. Anthracycline (p=0.006) and anti-HER2 therapy (p=0.023) had higher odds of cardiotoxicity. Age at diagnosis, BMI, and payer type did not reach statistical significance. Conclusions: Breast cancer and CV disease remain leading causes of death worldwide with SE factors influencing outcomes significantly. Within the multidisciplinary field of cardio-oncology, it is imperative to consider these disparities during care. Selected characteristics and outcomes by income quintile (N=80). Variable Overall Q1 <$30,704(n=7) Q2$30,704-58,908(n=29) Q3$58,909-92,937(n=24) Q4 $92,938-148,794(n=14) Q5 >$148,794(n=6) p-value Median Age at Diagnosis (years) 54.5 61 58 53 52 54 0.32 Median BMI (kg/m²) 30.8 40.7 31.6 30.4 28.4 25.9 0.2 Black, n (%) 43 (54) 7 (100) 16 (55) 14 (58) 6 (43) 0 (0) <0.01 Payer Private, n (%) 56 (70) 5 (71) 17 (59) 18 (75) 10 (71) 6 (100) 0.36 EF Change (baseline-lowest) -10 -15.5 -8.8 -10 -8 -12.8 0.58 Cardiotoxicity (New), n (%) 39 (49) 5 (71) 12 (41) 9 (39) 9 (64) 4 (67) 0.31 4-year Mortality, n (%) 5 (6) 0 (0) 3 (11) 1 (4) 0 (0) 1 (17) 0.49