Black Patients Experience Highest Rates of Cancer-associated Venous Thromboembolism

Abstract

Purpose: Cancer patients are at a higher risk of venous thromboembolism (VTE) than the general population. In the general population, blacks are at a higher risk of VTE compared with whites. The influence of race on cancer-associated VTE remains unexplored. We examined whether black cancer patients are at a higher risk of VTE and whether these differences are present in specific cancer types. Design: A retrospective study was performed in the largest safety net hospital of New England using a cohort of cancer patients characterized by a substantial number of nonwhites. Results: We identified 16,498 subjects with solid organ and hematologic malignancies from 2004 to 2018. Among them, we found 186 unique incident VTE events, of which the majority of the events accrued within the first 2 years of cancer diagnosis. Overall, blacks showed a 3-fold higher incidence of VTE (1.8%) compared with whites (0.6%; P<0.001). This difference was observed in certain cancer types such as lung, gastric and colorectal. In lung cancer, the odds of developing VTE in blacks was 2.77-times greater than those in white patients (confidence interval, 1.33-5.91; P=0.007). Despite the greater incidence of cancer-associated VTE in blacks, their Khorana risk score of VTE was not higher. Conclusions: In a diverse cancer cohort, we observed a higher incidence of cancer-associated VTE in blacks compared with patients from other races. This study indicates the consideration of race in the risk assessment of cancer-associated VTE. It could also lead to future mechanistic studies aiming at identifying reasons for differential VTE risk depending on cancer type.

Racial and Ethnic Disparities in Cancer-Associated Thrombosis

“…2 An observational study of 16,498 patients determined that among certain cancer types, including lung, gastric, and colorectal cancers, the unadjusted incidence rate in Black patients was three-fold greater compared to Whites (1.8% vs. 0.6%; p < 0.001). 3 Significantly higher rates of pulmonary embolism were reported in Black than White patients (27.6% vs. 14.4%; p < 0.0001), while the converse was true for deep vein thrombosis (51.9% vs. 59.5%; p ¼ 0.02). 5 These data suggest that the social, environmental, and epigenetic factors represented by race may mediate and modify CT risk.…”

“…The Khorana risk score, a commonly used CAT risk calculator, uses five variablescancer site, pre-chemotherapy platelet count, hemoglobin levels or use of red cell growth factors, leukocyte count, and body mass index [4]. Data suggest that the Khorana score does not accurately predict CAT risk in Black patients as predicted estimates are similar between Blacks and Whites despite a greater incidence in Blacks [3]. These findings underscore a need for patient-and race-specific metrics to improve risk prediction across diverse populations.…”

“…4 Data suggest that the Khorana score does not accurately predict CT risk in Black patients as predicted estimates are similar between Blacks and Whites despite a greater incidence in Blacks. 3 These findings underscore a need for patient- and race-specific metrics to improve risk prediction across diverse populations.…”

“…Known risk factors for cancer-associated thrombosis (CAT) include cancer type (brain, kidney and pancreatic), cancer stage, age, gender, recent surgery, and limited mobility. Studies also suggest that race and ethnicity contribute to increased CAT risk [3]. Black 2…”

“…Studies also suggest that race and ethnicity contribute to increased CT risk. 3 Black (African American) patients with cancer are three times more likely to develop CT compared with White patients with cancer, While Asian/Pacific Islanders have lower risk.…”