Trends in age and sex-specific prevalence of cancer and cancer subtypes in acute ischemic stroke from 2007-2019

Fadar Oliver Otite; Sana Somani; Ehimen Aneni; Emmanuel Akano; Smit D Patel; Nnabuchi Anikpezie; Olaoluwatomi Lamikanra; Hesham Masoud; Julius Gene Latorre; Seemant Chaturvedi; Prachi Mehndiratta

doi:10.1016/j.jstrokecerebrovasdis.2022.106818

Trends in age and sex-specific prevalence of cancer and cancer subtypes in acute ischemic stroke from 2007-2019

J Stroke Cerebrovasc Dis. 2022 Dec;31(12):106818. doi: 10.1016/j.jstrokecerebrovasdis.2022.106818. Epub 2022 Oct 29.

Authors

Affiliations

¹ Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA. Electronic address: otitef@upstate.edu.
² Department of Neurology, Georgetown University School of Medicine, Washington, D.C., USA.
³ Department of Cardiology, Yale University, New Haven, Connecticut, USA.
⁴ Molecular Neuropharmacological Unit, National Institute of Neurological Diseases and Stroke, NINDS, Bethesda, Maryland, USA.
⁵ Department of Neurosurgery, University of Connecticut, Hartford, Connecticut, USA.
⁶ Department of Population Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁷ Department of Critical Care, Springfield Clinic, Springfield, Illinois, USA.
⁸ Department of Neurology, State University of New York, Upstate Medical University, Syracuse, NY, USA.
⁹ Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.

PMID: 36323171
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106818

Abstract

Objective: To describe age and sex-specific prevalence of cancer in acute ischemic stroke (AIS) hospitalizations in the United States over the last decade.

Methods: We conducted a retrospective serial cross-sectional study using all primary AIS discharges (weighted n=5,748,358) with and without cancer in the 2007-2019 National Inpatient Sample. Admissions with primary central nervous system cancers were excluded. Joinpoint regression was used to compute the average annualized percentage change (AAPC) in cancer prevalence over time.

Results: Across the study period, 12.7% of AIS admissions had previous/active cancer, while 4.4% had active cancer. Of these, 18.8% were hematologic cancers, 47.2% were solid cancers without metastasis and 34.0% were metastatic cancers of any type. Age-adjusted active cancer prevalence differed by sex (males:4.8%; females:4.0%) and increased with age up to age 70-79 years (30-39 years 1.4%; 70-79 years:5.7%). Amongst cancer admissions, lung (18.7%) and prostate (17.8%) were the most common solid cancers in men, while lung (19.6%) and breast (13.7%) were the most prevalent in women. Active cancer prevalence increased over time (AAPC 1.7%, p<0.05) but the pace of increase was significantly faster in women (AAPC 2.8%) compared to men (AAPC 1.1%) (p-comparison =0.003). Fastest pace of increased prevalence was seen for genitourinary cancers in women and for gastrointestinal cancers in both sexes. Genitourinary cancers in men declined over time (AAPC -2.5%, p<0.05). Lung cancer prevalence increased in women (AAPC 1.8%, p<0.05) but remained constant in men. Prevalence of head/neck, skin/bone, gastrointestinal, hematological and metastatic cancers increased over time at similar pace in both sexes.

Conclusion: Prevalence of cancer in AIS admissions increased in the US over the last decade but the pace of this increase was faster in women compared to men. Gastrointestinal cancers in both sexes and genitourinary cancers in women are increasing at the fastest pace. Additional studies are needed to determine whether this increase is from co-occurrence or causation of AIS by cancer.

Keywords: Cancer; Epidemiological studies; Ischemic stroke; Prevalence.

MeSH terms

Aged
Cross-Sectional Studies
Female
Humans
Incidence
Ischemic Stroke*
Lung Neoplasms*
Male
Prevalence
Retrospective Studies
Stroke* / diagnosis
Stroke* / epidemiology
United States / epidemiology