Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors

Berkman, Amy M.; Brewster, Abenaa M.; Jones, Lee W.; Yu, Jun; Lee, J. Jack; Peng, Shaohua; Crocker, Abigail; Ater, Joann L.; Gilchrist, Susan C.

doi:10.1089/jayao.2017.0024

Cited by 18 publications

(14 citation statements)

References 52 publications

(53 reference statements)

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“…In a study of 79,176 AYA patients with cancer diagnosed in California during 1996-2012, the 10-year risk of incident CVD among African-Americans was 1.55 (95% CI: 1.33-1.81) times that among non-Hispanic Whites with adjustment for cancer type (28). Likewise, a prior SEER-based analysis of AYAs diagnosed at ages 15-34 from 1973 to 2011 found a nonsignificant increase in death from CVD among Black survivors compared with White (HR ¼ 1.33; 95% CI: 0.60-2.95), although estimates were imprecise and models did not appear to account for cancer type (29). Results of this study also indicate a higher burden of CVD mortality among non-Hispanic Black AYAs with cancer, but suggest that the magnitude of this disparity may be considerably greater than previously reported.…”

Section: Discussionmentioning

confidence: 95%

Disparities in Mortality from Noncancer Causes among Adolescents and Young Adults with Cancer

Anderson

Lund

Weaver

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Few studies have examined noncancer outcomes among patients diagnosed with cancer as adolescents and young adults (AYA). We examined risk of mortality from noncancer causes after an AYA cancer diagnosis and investigated disparities according to race/ethnicity and other characteristics. Methods: Patients with a first primary cancer at ages 15 to 39 years diagnosed during 1987 to 2015 were identified in the Surveillance, Epidemiology, and End Results database (N ¼ 242,940 women, 158,347 men). Survival months were accrued from diagnosis until death or December 2015. Multivariable-adjusted HRs were used to examine disparities in mortality from all noncancer causes, cardiovascular diseases (CVD), and infectious diseases (ID) according to race/ethnicity, geographic region, and county-level characteristics. Results: For all cancer types combined, the 10-year cumulative incidence of noncancer-related death after AYA cancer was 2% and 5% among women and men, respectively. With adjustment for cancer type, all noncancer mortality was increased among non-Hispanic Black AYAs [HR vs. non-Hispanic White: HR Women ¼ 2.31; 95% confidence interval (CI): 2.16-2.47; HR Men ¼ 2.17; 95% CI: 2.05-2.30] and those in the South (HR vs. Northeast: HR Women

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Section: Discussionmentioning

confidence: 95%

Disparities in Mortality from Noncancer Causes among Adolescents and Young Adults with Cancer

Anderson

Lund

Weaver

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…When socioeconomic risk factors were investigated, Black AYAs with any type of cancer had a higher risk of death from any cause (HR:1.9, 95% CI:1.8–2.0) [ 75 ] overall and specifically after HL [ 31 , 86 ] and testicular cancer [ 106 ] compared to non-Hispanic Whites. Non-Hispanic Black (HR:1.7; 95% CI:1.1–2.8) [ 81 ] AYA cancer survivors also experienced a greater risk of death from non-cancer causes.…”

Section: Resultsmentioning

confidence: 99%

The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review

Ryder‐Burbidge

Diaz

Barr

et al. 2021

Cancers

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Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.

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“…Five articles reported racial/ethnic disparities in survival rates (Table 5). Type of survival outcomes assessed for non-Hispanic Black survivors included all-cause mortality ( 22), allcause mortality including relative and standardized rates (31), subsequent malignancy mortality (22), risk of cardiovascularspecific death (25), and risk of any death (25). Types of survival metrics assessed for Hispanic survivors included allcause standardized mortality rates (31).…”

Section: Disparities In Survival Ratesmentioning

confidence: 99%

“…Specifically, one article found that inclusion of census-tract (i.e., neighborhood-level) SES removed the significance of death hazard for non-Hispanic Black survivors diagnosed with astrocytoma and non-astrocytoma CNS tumor, but not acute myeloid leukemia (30). Another article suggests that the adjustment individual and clinical factors removed the significance of cardiovascular-specific death for non-Hispanic Black survivors (25). However, another article found that disparities in all-cause relative mortality rates remained statistically significant for non-Hispanic Black and Hispanic survivors after adjusting for clinical factors, individual demographic and SES factors, and cardiovascular risk in the modeling (31).…”

Section: Disparities In Survival Ratesmentioning

confidence: 99%

“…It is possible that underlying biological mechanisms (e.g., inherited genetic predisposition to disease risks and epigenetic modifications due to life experiences or environmental exposures) and disadvantaged neighborhood environments may elevate disparities in chronic health conditions beyond the influence of individual SES and clinical risk. In survival rate, individual-level and neighborhood-level SES (22,30,31), together with age at cancer diagnosis (25,39) and years since diagnosis, played an important role for risk facilitation (26).…”

Section: Disparity-specific Risk Modulatorsmentioning

confidence: 99%

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Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

Reeves

Mathis

Bauer

et al. 2021

Front. Public Health

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The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

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Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors

Cited by 18 publications

References 52 publications

Disparities in Mortality from Noncancer Causes among Adolescents and Young Adults with Cancer

Disparities in Mortality from Noncancer Causes among Adolescents and Young Adults with Cancer

The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review

Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

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