Social disparities in cardiovascular mortality of patients with cancer in the USA between 1999 and 2019

Zahra Raisi-Estabragh; Ofer Kobo; Teresa López-Fernández; Husam Abdel Qadir; Nicholas Ws Chew; Wojtek Wojakowski; Abhishek Abhishek; Robert J H Miller; Mamas A Mamas

doi:10.1016/j.ijcrp.2023.200218

Social disparities in cardiovascular mortality of patients with cancer in the USA between 1999 and 2019

Int J Cardiol Cardiovasc Risk Prev. 2023 Oct 3:19:200218. doi: 10.1016/j.ijcrp.2023.200218. eCollection 2023 Dec.

Authors

Zahra Raisi-Estabragh^{1

2}, Ofer Kobo^{3

4}, Teresa López-Fernández⁵, Husam Abdel Qadir⁶, Nicholas Ws Chew⁷, Wojtek Wojakowski⁸, Abhishek Abhishek⁹, Robert J H Miller¹⁰, Mamas A Mamas^{4

11}

Affiliations

¹ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, UK.
² Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK.
³ Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.
⁴ Keele Cardiovascular Research Group, Keele University, Keele, UK.
⁵ Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain.
⁶ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷ Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
⁸ Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
⁹ Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom.
¹⁰ Libin Cardiovascular Institute of Alberta and University of Calgary, Calgary, AB, Canada.
¹¹ Institute of Population Health, University of Manchester, Manchester, UK.

Abstract

Background: Temporal trends of the impact of social determinants on cardiovascular outcomes of cancer patients has not been previously studied.

Objectives: This study examined social disparities in cardiovascular mortality of people with and without cancer in the US population between 1999 and 2019.

Methods: Primary cardiovascular deaths were identified from the Multiple Cause of Death database and grouped by cancer status. The cancer cohort was subcategorized into breast, lung, prostate, colorectal, and haematological. The number of cardiovascular deaths, crude cardiovascular mortality rate, cardiovascular age-adjusted mortality rate (AAMR), and percentage change in cardiovascular AAMR were calculated by cancer status and cancer type, and stratified by sex, race, ethnicity, and urban-rural setting.

Results: 17.9 million cardiovascular deaths were analysed. Of these, 572,222 occurred in patients with a record of cancer. The cancer cohort were older and included more men and White racial groups. Regardless of cancer status, cardiovascular AAMR was higher in men, rural settings, and Black or African American races. Cardiovascular AAMR declined over time, with greater reduction in those with cancer (-51.6% vs -38.3%); the greatest reductions were in colorectal (-68.4%), prostate (-60.0%), and breast (-58.8%) cancers. Sex, race, and ethnic disparities reduced over time, with greater narrowing in the cancer cohort. There was increase in urban-rural disparities, which appeared greater in those with cancer.

Conclusions: While most social disparities narrowed over time, urban-rural disparities widened, with greater increase in those with cancer. Healthcare plans should incorporate strategies for reduction of health inequality equitable access to cardio-oncology services.

Keywords: Cardio-oncology; Race; Social determinants of health; Urbanisation; Women's health.