Understanding and Reducing Racial Disparities in High Risk Cardio-Oncology Communities

Race-associated differences in health outcomes have been described in various populations in the United States, but remain poorly understood, particularly in cardio-oncology. Black Americans have a nearly 30% increased cardiovascular disease mortality and an overall shorter life expectancy by 3.4 years as compared to Whites. Moreover, survival after an out-of-hospital cardiac arrest is worse in Blacks and Hispanics, and most recent data indicate that overall age-adjusted mortality rates are worsening in Blacks and Hispanics. Broad and deep racial and ethnic disparities exist with cardiovascular risk factor and disease control. Similar inequities also exist in oncology, with marked variability in cancer prevention, early detection and treatment outcomes according to race and ethnicity. For example, Black race is associated with worse prognosis in breast cancer; Blacks present with tumors with more advanced features (stage, hormonal status and size) and suffer 50% worse survival compared with Whites. Similarly, the incidence of prostate cancer is 64% greater in Blacks compared to Whites, and is associated with a 134% increased mortality. Race is both a biologic and social construct. The impact of the biology of race on cardiovascular disease risk remains incompletely defined, particularly in cardio-oncology. Similarly, the social construct of race is also poorly understood in cardio-oncology. Despite an established association between race and health in human disease, critical knowledge gaps remain, including how mechanisms of cancer therapy cardiotoxicity differ by race and how structural inequities affect cardiotoxicity risk in cancer patients and survivors. Moreover, strategies to mitigate racial inequities and improve overall health in historically marginalized cancer survivors do not yet exist. The overall objective of our proposed research network is to comprehensively define and mitigate the biologic, structural and personal determinants of racial disparities