All-cause, CVD mortality highest in Black patients among those with cancer
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Researchers observed significant racial disparities in all-cause and CVD mortality among adults with cancer, with wider gaps found among patients younger than 55 years, according to a study published in JACC: CardioOncology.
“Accessible, high-quality cardio-oncology care is the key to equitable CVD outcomes among cancer patients and survivors,” Cenjing Zhu, MPHIL, PhD candidate in chronic disease epidemiology at the Yale School of Public Health, and colleagues wrote. “Despite having more health care needs, cancer survivors of underserved racial and ethnic groups often face significant barriers to high-quality care that have been further amplified during the ongoing COVID-19 pandemic.”
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Using Surveillance, Epidemiology and End Results (SEER) data collected between 2000 and 2018, Zhu and colleagues compared all-cause and CVD mortality among more than 3.6 million adult patients with cancer by race/ethnicity group.
Overall, 73.6% of patients were white, 11% were Black, 9% were Hispanic, 6.1% were Asian/Pacific Islander and 0.4% were American Indian/Alaska Native.
The 10 most prevalent cancer types were included: breast cancer, colorectal cancer, corpus uteri, kidney and renal pelvis cancer, larynx cancer, lung and bronchus cancer, melanoma, non-Hodgkin lymphoma, prostate cancer and urinary bladder cancer.
Between 2000 and 2018, 44.7% of the cohort died, and 6.3% of deaths were reported as a result of CVD.
Cancer and all-cause mortality
After adjusting for sociodemographic and clinical characteristics, Black patients with cancer had higher risk for all-cause mortality (HR = 1.13; 95% CI, 1.13-1.14) compared with white patients.
Researchers also observed increased risk for all-cause mortality among American Indian/Alaska Native patients compared with white patients (HR = 1.1; 95% CI, 1.08-1.13); however, Hispanic (HR = 0.98; 95% CI, 0.97-0.99) and Asian/Pacific Islander patients (HR = 0.85; 95% CI, 0.84-0.85) had lower risk for all-cause mortality compared with white patients.
The relationship between race/ethnicity and all-cause mortality was more pronounced in patients aged 18 to 54 years compared with those 55 years and older (P for interaction < .001), according to the study.
Cancer and CVD mortality
The researchers reported that Black patients had a 25% greater cumulative risk for CVD death compared with white patients (HR = 1.25; 95% CI, 1.23-1.27). Hispanic (HR = 0.81; 95% CI, 0.79-0.82), Asian/Pacific Islander (HR= 0.78; 95% CI, 0.78-0.8) and American Indian/Alaska Native (HR = 0.95; 95% CI, 0.89-1.03) patients each had lower risk for CVD mortality compared with white patients.
The relationship between race/ethnicity and CVD mortality was most pronounced in patients aged 18 to 54 years, with Black individuals having an increased cumulative risk compared with white patients (HR = 1.76; 95% CI, 1.67-1.85); however, Hispanic (HR = 0.79; 95% CI, 0.73-0.85) and Asian/Pacific Islander patients (HR = 0.85; 95% CI, 0.77-0.95) had lower risk compared with white patients (P for interaction for all < .001).
“Using a large population-based cancer registry, our study found significant race and ethnic differences in both all-cause and CVD-specific mortality among U.S. adult cancer patients, especially among younger patients and those with localized cancer,” the researchers wrote. “Our findings underscore the vital role of accessible cardiovascular interventions and highlight the need to identify high-risk cancer populations who may benefit most from early and long-term survivorship care.”
In a related editorial, Michael C. LeCompte, MD, MS, a resident in the department of radiation oncology and molecular radiation sciences, and Otis W. Brawley, MD, professor of oncology and 39th Bloomberg Distinguished Professor, both at Johns Hopkins University, discussed how factors outside of cancer diagnosis could impact risk for all-cause and CVD mortality among historically underrepresented populations.
“The poor, known to include many racial and ethnic minorities, are more prone to receive care in resource-poor clinical environments. Largely because of education and economic deprivation, healthful behaviors are less likely to be adopted in these populations. Throughout life, preventive services are more often lacking,” LeCompte and Brawley wrote. “More emphasis should be put on the fact that there are significant disparities in disease influences, which in turn cause disparity in disease development and in some cases even disparities in the aggressiveness of disease. The influences that cause disease are often pressures over years and even decades.”
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