Investigating the Impact of Neighborhood Deprivation Level on Cardiovascular Burden in Adolescent and Young Adult Lymphoma Survivors

Abstract

Social determinants of health (SDOH) studies have underscored the impact of the local environment on both cancer outcomes and cardiovascular health. Adolescent and young adult (AYA) lymphoma survivors are commonly treated with cardiotoxic treatments that increase risk of poor cardiovascular outcomes. Thus, investigations of neighborhood-level measures and cardiovascular burden in diverse AYA lymphoma populations may provide insight into mediators of disparities in AYA lymphoma survivors. This study utilizes a multi-ethnic cohort of AYA lymphoma survivors (N=353), diagnosed between ages 15-39, seen at MD Anderson Cancer Center. Clinical data abstraction for demographics, treatment, and follow-up information was completed. Follow-up data includes cardiovascular-related variables, such as BMI at baseline and last follow-up, diagnoses of hypertension, hyperlipidemia, heart failure and other cardiovascular diseases, and treatment with cardiovascular medications. Zip codes obtained from the medical record were used to query the U.S. Census Bureau to gather zip-code tabulation areas (ZCTA). Each ZCTA was linked with their associated Area Deprivation Index (ADI) values from the Public Health Neighborhood Atlas (University of Wisconsin). Clinical data and ADI values were evaluated to identify differences in poor cardiovascular burden by ADI and by ethnic group. The cohort includes 275 (77.9%) non-Hispanic white, 29 (8.2%) non-Hispanic Black, and 49 (13.9%) Hispanic cancer survivors (2+ years from diagnosis). The mean ADI value was 46.4 for the non-Hispanic whites, 58.2 for the non-Hispanic Blacks, and 55.5 for the Hispanic population. In total, 276 (78.2%) of the population was diagnosed with Hodgkin lymphoma and 77 (21.8%) with non-Hodgkin lymphoma. Based on the survivors with available clinical data, 34 (64.2%) had a cardiovascular disease (CVD) diagnosis and 43 (71.7%) were taking cardiac medications at follow-up. Differences in ADI between AYA lymphoma survivors by self-identified race/ethnicity were observed that suggest non-White AYA survivors experience higher burdens of poor SDOH compared their White AYA counterparts. Patients with a diagnosis of CVD and patients taking cardiac medications had higher ADI levels than those without, significantly so regarding cardiac medications. Survival of the multi-ethnic cohort by ADI quartiles was not significantly different, but when analyzed by highest versus lowest quartile some disadvantage was evident. Further analysis is needed to elucidate this relationship and provide sufficient evidence for potential social interventions.