Abstract Body (Do not enter title and authors here): Background: The potential impact of neighborhood environment, a key structural social determinant of health, on disparities in cardiometabolic risk in cancer patients remains incompletely defined. We sought to determine the associations between environmental burden and cardiometabolic risk factors, and if these associations differed by race.
Methods: Breast cancer patients initiating anthracycline and/or trastuzumab therapy at a multi-site health system were enrolled in a longitudinal prospective cohort study (NCT 05078190). At baseline, prior to cancer therapy initiation, neighborhood environment was defined by utilizing the Environmental Burden Module of the Environmental Justice Index from the CDC/ATSDR. The prevalence of cardiometabolic risk factors (hypertension, diabetes mellitus, dyslipidemia, obesity [BMI ≥30kg/m²], physical activity (PA) as defined by the Godin Leisure Time Questionnaire) was also ascertained. Sufficient PA was defined by a moderate-to-vigorous PA score ≥24. Age-adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models.
Results: Among 184 study participants (median [Q1-Q4] age 51 [43-60], 27.7% Black race), Black patients had greater (worse) environmental burden (0.83 [0.72-0.92]) compared to White patients (0.79 [0.46-0.87]). Patients with worse environmental burden were significantly less likely to meet sufficient PA levels (Q4 vs Q1 aOR 0.26, 95% CI 0.09-0.67), and more likely to have obesity (Q4 vs Q1 aOR 2.39, 95% CI 1.02-5.78). No significant associations were found with other cardiometabolic risk factors. In exploratory analysis stratified by race, associations between environmental burden and PA were more pronounced in Black patients, while associations between environmental burden and obesity were more pronounced in White patients (Table).
Conclusions: Environmental burden was associated with PA and obesity in patients with breast cancer prior to the initiation of anthracycline and/or trastuzumab. Our findings motivate additional work in defining how environmental burden impacts cardiometabolic risk with cancer therapy longitudinally and disparities in cardiometabolic risk according to race.