CV risk factor disparities in childhood cancer survivors similar to general population
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Key takeaways:
- By age 40 years, Black and Hispanic survivors of childhood cancer had more cardiovascular risk factors compared with white survivors.
- The differences were similar to those in the American general population.
The disparate prevalence of cardiovascular risk factors among adult Black and Hispanic survivors of childhood cancer was comparable to the disparities in the American general population, researchers reported.
Findings from an analysis of the Childhood Cancer Survivor Study (CCSS) were published in JACC: CardioOncology.
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“Marked improvements in pediatric oncology care over the past half-century have come at the expense of significant cardiotoxic exposures with subsequent CVD later in life. Despite improvements in overall cancer survival, significant health inequities by race/ethnicity persist in morbidity and mortality,” David H. Noyd, MD, MPH, adjunct assistant professor in the department of pediatrics at Duke University and assistant professor of pediatric hematology/oncology at the University of Oklahoma Health Sciences Center, and colleagues wrote. “This analysis aimed to build on previously identified disparities by race/ethnicity of CV risk factors among survivors in the original CCSS cohort. ... Specifically, comparisons with the CCSS sibling cohort and a referent population from the National Health and Nutrition Examination Survey sought to understand whether the pattern of disparities in CV risk factors among survivors by race/ethnicity differed from those identified in the general population.”
The Childhood Cancer Survivor Study
The CCSS was a retrospective study that included 25,656 survivors of childhood cancer diagnosed between 1970 and 1999 who survived at least 5 years after initial diagnosis. Within this cohort, cancer diagnoses included leukemia, central nervous system malignancy, Hodgkin lymphoma, non-Hodgkin lymphoma, Wilms’ tumor, neuroblastoma, soft tissue sarcoma or bone tumor.
For the present analysis, Noyd and colleagues conducted a multivariable piecewise exponential regression model using CCSS, CSSS sibling and NHANES data to compare the incidence of hypertension, hyperlipidemia, diabetes, obesity and the presence of two or more CV risk factors by race/ethnicity of adult childhood cancer survivors, and compared those data with the general population.
Disparities among adult childhood cancer survivors
By age 40 years, Black and Hispanic survivors of childhood cancer reported higher cumulative incidence of diabetes, obesity and multiple CV risk factors compared with white survivors. Black survivors of childhood cancer had greater incidence of hypertension compared with Hispanic and white survivors (P for all < .001).
After controlling for sociodemographic and treatment factors, Black survivors of childhood cancer had greater incidence of hypertension (incidence rate ratio [IRR] = 1.4; 95% CI, 1.1-1.8), obesity (IRR = 1.7; 95% CI, 1.4-2.1) and multiple CV risk factors (IRR = 1.6; 95% CI, 1.2-2.1) compared with white survivors.
Compared with white survivors of childhood cancer, Hispanic survivors had increased incidence of diabetes (IRR = 1.8; 95% CI, 1.2-2.6) and obesity (IRR = 1.4; 95% CI, 1.2-1.7).
The researchers observed no significant differences in hyperlipidemia by race/ethnicity.
These racial/ethnic differences in CV risk factors observed in the CCSS cohort were similar within the CCSS sibling and NHANES cohorts, according to the study.
“These differences by race/ethnicity persisted despite the adjustment for treatment exposures and socioeconomic factors, thus motivating additional investigation into potential systemic causes of these differences and possibly differences in genetic predisposition to late cardiac outcomes, such as cardiomyopathy,” the researchers wrote. “In the United States, childhood cancer survivors in the CCSS demonstrate a substantial burden of disease for each CV risk factor with cumulative incidence estimates ranging from 5% (diabetes) to 50% (obesity) by age 40, thus further stressing the opportunity to promote equity in cardiovascular health on a population level.”
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