Racial and Ethnic Disparities in All-Cause and Cardiovascular Mortality Among Cancer Patients in the U.S.

Zhu, Cenjing; Shi, Tong; Jiang, Changchuan; Liu, Baoqiong; Baldassarre, Lauren A.; Zarich, Stuart

doi:10.1016/j.jaccao.2022.10.013

Cited by 22 publications

(19 citation statements)

References 36 publications

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“…The disproportionately increased risk for hypertension among Black cancer survivors may contribute to the well described disparities in cardiovascular outcomes after cancer diagnosis. 15,16 Similar to previous studies, we found that after controlling for traditional hypertension risk factors, Black breast cancer survivors had a higher prevalence of hypertension than White survivors at the time of their breast cancer diagnosis. 17,18 Our study further contributes to the literature by examining the rates of hypertension development in previously normotensive women after a breast cancer diagnosis.…”

Section: Discussionsupporting

confidence: 89%

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Examining hypertension risk among Black and White breast cancer survivors

Sutton,

He,

Bottinor

et al. 2024

Cancer Medicine

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PurposeBreast cancer survivors are at increased risk of cardiovascular dysfunction following their diagnosis; however, hypertension remains underexplored within this context. This retrospective cohort study examined the incidence of hypertension in breast cancer survivors and the association of race with hypertension risk among them.MethodsData for this study were abstracted from the electronic health records of women diagnosed with Stages I–III breast cancer. Incident hypertension diagnosis was identified through International Classification of Diseases codes. Bivariate associations were tested using Student's t‐test and chi‐squared test of independence. Bivariable Cox regression analysis was used to determine demographic and clinical factors that may have been associated with the development of hypertension.ResultsA total of 664 women were included. Most women were 50 years of age or younger (52.0%), White (33.0% Black), and received a mastectomy (80.6%). Overall, 45.5% of the cohort developed hypertension. The 1‐year hypertension‐free survival estimates were 47% (95% confidence interval [CI], 41–54) in Black women and 73% (95% CI, 69–77) in White women (p < 0.0001). Besides race, statistically significant predictors of hypertension included: age greater than 50 (vs. ≤50) (adjusted Hazard Ratio [HR]: 1.40; 95% CI, 1.09–1.80) and residing in a non‐metropolitan area (vs. metropolitan) (adjusted HR: 1.60; 95% CI, 1.19–2.16).ConclusionsThis study suggests that breast cancer survivors who are older, Black, or residing in non‐metropolitan areas may benefit from added surveillance and hypertension prevention strategies during treatment. Future studies are needed to identify contributors to the observed racial and geographic disparities.

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Section: Discussionsupporting

confidence: 89%

“…Living in a non‐metropolitan area (vs. a metropolitan area) was associated with increased risk of hypertension. The disproportionately increased risk for hypertension among Black cancer survivors may contribute to the well described disparities in cardiovascular outcomes after cancer diagnosis 15,16 …”

Section: Discussionmentioning

confidence: 99%

Examining hypertension risk among Black and White breast cancer survivors

Sutton,

He,

Bottinor

et al. 2024

Cancer Medicine

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“…Although no studies have specifically addressed cardio-oncology disparities †Increased CVD mortality rate also reported in American Indian individuals with any prior cancer treatment. 28 in this population, their presence can be inferred from the known CVD and oncology disparities.…”

Section: Cardiotoxicity In the Lgbtqia+ Communitymentioning

confidence: 99%

“…25,26 Despite these observations, available Surveillance, Epidemiology, and End Results–based data suggest that Black patients still see increased CVD and mortality risk after a cancer diagnosis, even after accounting for socioeconomic, cancer stage, and treatment-related factors (Table 1). 27–29 This suggests an independent risk not explained by increased rates of hypertension or other traditional cardiac factors alone. However, traditional risk factor burden has been identified to partially contribute to global cancer therapy–related cardiac disease risk in all populations.…”

Section: Population-specific Considerationsmentioning

confidence: 99%

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

Morrison¹,

Baik²,

Fradley³

et al. 2023

Circulation

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Advances in cancer therapeutics have revolutionized survival outcomes in patients with cancer. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Recent studies have uncovered excess risks of these cardiotoxic events, especially in traditionally underrepresented populations. Despite advances in strategies to limit the risks of cardiovascular events among cancer survivors, relatively limited guidance is available to address the rapidly growing problem of disparate cardiotoxic risks among women and underrepresented patient populations. Previously decentralized and sporadic evaluations have led to a lack of consensus on the definitions, investigation, and potential optimal strategies to address disparate cardiotoxicity in contemporary cancer care (eg, with immunotherapy, biologic, or cytotoxic therapies) settings. This scientific statement aims to define the current state of evidence for disparate cardiotoxicity while proposing uniform and novel methodological approaches to inform the identification and mitigation of disparate cardio-oncology outcomes in future clinical trials, registries, and daily clinical care settings. We also propose an evidence-based integrated approach to identify and mitigate disparities in the routine clinical setting. This consensus scientific statement summarizes and clarifies available evidence while providing guidance on addressing inequities in the era of emerging anticancer therapies.

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“…In child, adolescent, and adult DLBCL survivors, CVM might be related to disease stages, treatment modalities, and genetic factors ( 6 , 7 , 11 ). The challenges in estimating CVM risks have been highlighted in previous studies ( 5 , 7 , 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram for predicting cardiovascular mortality risk for diffuse large B-cell lymphoma in children, adolescents, and adults

Mu,

Zhang,

et al. 2024

Front. Pediatr.

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ObjectiveThis study aimed to construct and validate a nomogram for predicting cardiovascular mortality (CVM) for child, adolescent, and adult patients with diffuse large B-cell lymphoma (DLBCL).Materials and methodsPatients with only one primary tumor of DLBCL first diagnosed between 2000 and 2019 in the SEER database were extracted. We used the cumulative incidence function (CIF) to evaluate the cumulative rate of CVM. The outcome of interest was CVM, which was analyzed using a competing risk model, accounting for death due to other causes. The total database was randomly divided into a training cohort and an internal validation cohort at a ratio of 7:3. Adjustments were for demographics, tumor characteristics, and treatment modalities. Nomograms were constructed according to these risk factors to predict CVM risk at 5, 10, and 15 years. Validation included receiver operating characteristic (ROC) curves, time-dependent ROC, C-index, calibration curves, and decision curve analysis.ResultsOne hundred four thousand six hundred six patients following initial diagnosis of DLBCL were included (58.3% male, median age 64 years, range 0–80, White 83.98%). Among them, 5.02% died of CVM, with a median follow-up time of 61 (31–98) months. Nomograms based on the seven risk factors (age at diagnosis, gender, race, tumor grade, Ann Arbor stage, radiation, chemotherapy) with hazard ratios ranging from 0.19–1.17 showed excellent discrimination, and calibration plots demonstrated satisfactory prediction. The 5-, 10-, and 15-year AUC and C-index of CVM in the training set were 0.716 (0.714–0.718), 0.713 (0.711–0.715), 0.706 (0.704–0.708), 0.731, 0.727, and 0.719; the corresponding figures for the validation set were 0.705 (0.688–0.722), 0.704 (0.689–0.718), 0.707 (0.693–0.722), 0.698, 0.698, and 0.699. Decision curve analysis revealed a clinically beneficial net benefit.ConclusionsWe first built the nomogram model for DLBCL patients with satisfactory prediction and excellent discrimination, which might play an essential role in helping physicians enact better treatment strategies at the time of initial diagnosis.

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Racial and Ethnic Disparities in All-Cause and Cardiovascular Mortality Among Cancer Patients in the U.S.

Cited by 22 publications

References 36 publications

Examining hypertension risk among Black and White breast cancer survivors

Examining hypertension risk among Black and White breast cancer survivors

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

Development and validation of a nomogram for predicting cardiovascular mortality risk for diffuse large B-cell lymphoma in children, adolescents, and adults

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