Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States

Sarju Ganatra, Sourbha S. Dani, Ashish Kumar, Safi U. Khan, Rishi Wadhera, Tomas G. Neilan, Paaladinesh Thavendiranathan, Ana Barac, Joerg Hermann, Monika Leja, Anita Deswal, Michael Fradley, Jennifer E. Liu, Diego Sadler, Aarti Asnani, Lauren A. Baldassarre, Dipti Gupta, Eric Yang, Avirup Guha, Sherry Ann BrownJennifer Stevens, Salim S. Hayek, Charles Porter, Ankur Kalra, Suzanne J. Baron, Bonnie Ky, Salim S. Virani, Dhruv Kazi, Khurram Nasir, Anju Nohria

Research output: Contribution to journalArticlepeer-review


Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.

Original languageEnglish (US)
Pages (from-to)326-337
Number of pages12
JournalJACC: CardioOncology
Issue number3
StatePublished - Sep 2022
Externally publishedYes


  • disparities
  • epidemiology
  • risk factor

ASJC Scopus subject areas

  • Oncology
  • Cardiology and Cardiovascular Medicine


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