Marginalized Cancer Survivors Have High Risk of New-Onset Cardiovascular Disease


Several factors among cancer survivors, such as rural residence, low income, and low education were found to be independently associated with a higher risk of developing new-onset cardiovascular disease.

Survivors of cancer who are part of a marginalized population, including those in rural areas, with low income, and those with low education, have a higher risk of developing new-onset cardiovascular disease (CVD) and should be considered when operationalizing lifestyle modification plans, according to a population-based analysis published in the Journal of Clinical Oncology.

A total of 23,926 survivors (29.4%) included in the analysis developed new-onset CVD, the most common disease types being cardiac arrhythmias (11.7%), cerebrovascular accidents (7.1%), congestive heart failure (5.3%), and myocardial infarctions (3.7%). Additionally, multiple types of CVD were identified in 1.6% of all patients. Patients with lung cancer had the highest incidence of developing CVD (36.9%), with melanoma having the lowest incidence (20.5%). Further, those with head and neck cancer had the highest occurrence of more than 1 type of CVD.

The highest proportion of patients who developed new-onset CVDs were those who had low education (30.7% vs 27.6%; P < .001), had low income (30.4% vs 25.9%; P < .001), and resided within a rural area (32.3% vs 28.5%; P < .001) vs their counterparts. All included CVDs were more common in individuals with low income and education, as well as those living in rural areas. Among those who reside within rural areas, 86.1% had a lower education vs 50% of those residing in urban areas. Additionally, those with a higher education were more likely to have a higher income. Individuals from rural areas who had a low education and income had the highest risk of developing CVD compared with those from urban areas who had a high income and low education.

“There is a significant risk of developing new-onset CVDs in patients with nonmetastatic solid organ cancers. Of all CVDs, diagnosis of CHF is associated with decreased OS, which was more likely to be diagnosed in patients with breast cancer and those who received chemotherapy. Socioeconomic factors are associated with the development of new-onset CVDs, particularly within marginalized communities. Such disparities persist, even in a publicly funded health care system. Lifestyle modifications and increased cardiac surveillance that may be provided by

the primary care physician could increase the outreach to underserved communities of cancer survivors,” the investigators wrote.

The population-based retrospective study included data that were pulled from several sources, including the Alberta Cancer Registry, the National Ambulatory Care Reporting System, discharge abstract database, billing claims, Vital Statistics, and the 2011 Canadian Census.

Investigators included patients between January 1, 2004 to December 31, 2017 who were over 18 years old when diagnosed with stage I to III solid organ cancer with the exception of non-melanoma skin cancer. Moreover, patients who had pre-existing CVDs such as cardiac arrhythmias, cerebrovascular accidents, congestive heart failure, and myocardial infarctions and those who had less than 1 year of follow-up data were not included in the analysis.

A total of 81,418 patients with stage I to III disease were identified by investigators, with a median age of 62 years (interquartile range, 54-71). The majority of the population were women (54.3%). Additionally, 26.2% of patients had a Charlson comorbidity index score of 1, and 12.9% had a score of 1 or more. Disease types included breast (28.6%), genitourinary (28.6%), gastrointestinal (19.8%), lung (8.7%), gynecologic (8.5%), melanoma (3.8%), and head and neck (2.0%) cancers. Additionally, 39.9%, 37.3%, and 22.8% of patients had stage I, II, and III cancer, respectively. Most patients resided within low socioeconomic status neighborhoods, with 77.3% having low income and 57.2% having low education.

Baseline Characteristics of Patients With Cancer (n = 581,418)

Baseline Characteristics of Patients With Cancer (n = 581,418)

After adjusting for baseline characteristics, the multivariable analysis indicated that factors such as lower socioeconomic status, (odds ratio (OR), 1.14; 95% CI, 1.09-1.19; P < .001), low education (OR, 1.04; 95% CI, 1.01-1.08; P = .043), and rural residence (OR, 1.08; 95% CI, 1.03-1.12; P < .001) were predictive of the development of new-onset CVD. Other factors associated with the development of new-onset CVD included advancing age (OR, 1.05; 95% CI, 1.04-1.05; P < .001), male sex (OR, 1.29; 95% CI, 1.23-1.35; P < .001), and comorbidities at baseline (CCI 1; OR, 1.27; 95%, 1.22-1.31; P < .001; score >1; OR, 1.53; 95%, 1.46-1.60; P < .001).


Batra A, Kong S, Cheung WY. Associations of socioeconomic status and rurality with new-onset cardiovascular disease in cancer survivors: a population-based analysis. J Clin Oncol. 2021. doi:10.1200/OP.20.01053

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