COVID-19 mortality risk twice as high among people with cancer
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Key takeaways:
- Individuals with cancer had significantly higher risk for COVID-19 mortality than the general population.
- Men, unmarried individuals, and Hispanic and African American individuals had elevated risk.
People with cancer had more than double the risk for COVID-19 mortality than the general population, according to study results.
Older adults, men, unmarried individuals, and Hispanic or African American individuals exhibited elevated risks, results of the population-based study showed.
“This study highlights the broader issue of health disparities in the context of COVID-19 and cancer,” Nicholas G. Zaorsky, MD, MS, vice chair of education in the radiation oncology department at University Hospital Seidman Cancer Center at Case Western Reserve School of Medicine, told Healio. “The disproportionately high mortality rates among minority groups and unmarried individuals suggest that social determinants of health play a significant role in outcomes.”
Background and methods
As of May 2023, more than 765 million COVID-19 infection diagnoses and 6.9 million deaths worldwide had been confirmed, according to study background.
Prior studies showed people with cancer are at increased risk for COVID-19.
“We felt it was crucial to investigate the COVID-19 mortality risk [among] patients living with cancer because existing studies, particularly from the United States, were limited in scope,” Zaorsky said. “[Although] international research highlighted the increased vulnerability of patients with cancer to COVID-19, there was a lack of large-scale, population-based studies in the U.S. that could offer a comprehensive understanding of the specific risk factors for COVID-19 mortality in this group.”
Zaorsky and colleagues used the SEER database to identify more than 4 million people in the United States who had been diagnosed with one of 15 invasive cancer types between 2000 and 2020. All people in the cohort either remained alive at follow-up or had died in 2020.
COVID-19 mortality served as the primary endpoint.
Results and next steps
Researchers determined 291,323 individuals in the cohort died, including 14,821 who died of COVID-19.
Only ischemic heart disease (5.2%) caused more noncancer-specific deaths in the cohort than COVID-19 (5.1%).
People with cancer exhibited significantly increased risk for COVID-19 mortality compared with the general population (standardized mortality ratio = 2.3; 95% CI, 2.26-2.34).
“The standardized mortality ratios for death due to COVID-19 were elevated for all clinical covariates in this study compared with the general population,” researchers wrote.
Among individuals with cancer, multiple subgroups had increased risk for COVID-19 mortality. These included men (HR vs. women = 1.46; 95% CI, 1.4-1.51), those aged 80 years or older (HR vs. age 49 years or younger = 21.47; 95% CI, 19.34-23.83), unmarried individuals (HR vs. married individuals = 1.47; 95% CI, 1.42-1.53), Hispanic individuals (HR vs. white individuals = 2.04; 95% CI, 1.94-2.14) and non-Hispanic African American individuals (HR vs. white individuals = 2.03; 95% CI, 1.94-2.14).
“The results were both expected and revealing,” Zaorsky said. “We anticipated that patients with cancer would have a higher risk for COVID-19 mortality due to their immunocompromised status, but the extent of the increased risk — particularly among specific subgroups such as older adults, males and certain racial and ethnic minorities — was striking.
“One surprising finding was the significant impact of marital status, with unmarried patients having a notably higher risk, which underscores the potential role of social support in health outcomes,” Zaorsky added. “Additionally, the fact that COVID-19 emerged as the second leading cause of noncancer death among this population was notable, highlighting the severe impact of the pandemic on patients living with cancer.”
Researchers acknowledged study limitations, including the fact they only had data from 2020 and the potential for variability among different regions in the U.S.
Future research should evaluate whether COVID-19 vaccination reduced mortality for patients with cancer, its impact on new variants, as well as interventions to decrease risk for COVID-19 among high-risk groups, Zaorsky said.
“The findings recommend prioritizing these patients for COVID-19 vaccination and preventive measures, and suggest the development of survivorship programs tailored to the particular challenges faced by patients with cancer during the pandemic,” he added.
For more information:
Nicholas G. Zaorsky, MD, MS, can be reached at nicholas.zaorsky@uhhospitals.org.
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