Cancer survivors face disparities in cardiovascular health and mortality

Cancer survivors with a history of childhood and young adult cancer face an increased risk of cardiovascular disease (CVD), according to recent research findings, which are influenced by race, insurance coverage have been found to be associated with factors such as treatment history.

CVD is the second leading cause of late death among cancer survivors (following subsequent malignancies), with a disproportionate incidence of cardiovascular risk factors (CVRF) among non-Hispanic black and Hispanic survivors “Promoting cardiovascular health equity is critical at this high level of cancer survivors.” the authors write.

Research published in journals JACC: Cardiac Oncology, In an analysis of data from more than 16,000 participants in a childhood cancer study, 1,092 non-Hispanic black survivors and 1,405 Hispanic survivors had diabetes compared with 13,960 non-Hispanic white survivors. was found to have a higher prevalence of pneumonia (8.4% and 9.7% vs. 5.1%). , obesity (47.2% and 48.9% compared with 30.2%), multiple CVRF (17.7%, 16.6% and 12.3%, respectively), and hypertension by age among non-Hispanic black survivors among 40 (19.5%, 13.6%, 14.3%).

When controlling for sociodemographic and treatment factors compared with non-Hispanic white survivors, the incidence rate ratio (IRR) for non-Hispanic black survivors was higher for hypertension (1.4), obesity (1.7), The incidence rate ratio (IRR) for non-Hispanic black survivors was higher for multiple CVRF experiences (1.6), whereas it was higher for diabetes (1.8) and obesity among Hispanic survivors, according to April 2023 statistics (1.4) was high Jack study.

Author of the April 2023 issue Jack The study also noted that chemotherapy, especially anthracyclines and chest radiation, were “established to have direct cardiotoxicity,” in approximately 61% of non-Hispanic black and Hispanic survivors. had anthracycline exposure compared with half of non-Hispanic white survivors, -Hispanic white survivors compared with non-Hispanic black and Hispanic survivors had more chest irradiation were likely to have received high-dose radiation therapy from

Another study of about 13,000 patients with a cancer diagnosis between the ages of 18 and 39 found: JACC: Cardiac Oncologyfound that with a median follow-up of 3.4 years, there were 180 heart failure events and 714 (5.5%) deaths, with a mean age at heart failure diagnosis of 31.6 years. Among young adult cancer survivors exposed to anthracyclines, the 5-year incidence of heart failure was 4%, compared with 1.3% among survivors who did not receive anthracycline treatment.

Nearly 70% of Cardiac Events Can Be Caused by ‘Suboptimal Cardiovascular Health’, April 2023 Jack In addition to the higher prevalence of diabetes in the general population, the study authors found that non-Hispanic blacks and Hispanic adults “compared with NHWs[non-Hispanic]have better diabetes control and optimal blood pressure.” It is highly unlikely that we will reach our target.” Caucasian) adults,” citing the American Heart Association’s designation of “structural racism as a major cause of observed disparities in cardiovascular health.”

“Achieving the overarching goal of achieving health equity for all childhood cancer survivors requires removing barriers to care, evidence-based interventions for CVRF suppression, and eliminating structural racism. A concerted effort to improve CVRF is essential to reduce the CVRF disparities observed in the CCSS cohort,” wrote the authors of the April study.

The role of insurance in CVD mortality

According to the 2021 study on insurance disparities, uninsured or Medicaid cancer patients receive Medicaid coverage regardless of CVD type, cancer site, year of diagnosis or follow-up period. CVD mortality was significantly higher than cancer patients who were not enrolled in HIV. A paper on cardiovascular mortality among non-elderly cancer survivors has been published. cardiac oncology.

The study used data from the Surveillance, Epidemiology, and End Results (SEER) program of more than 768,000 patients aged 18 to 64 years at diagnosis and found that 83.8% of white patients were non-Medicaid. was found to be the subject of With insurance coverage, that figure was only 68.4% for patients of other races.

Of the study participants, 1.1% died from CVD.

“The frequency of cardiovascular disease deaths varies significantly by insurance status, with the highest rate of death among Medicaid participants (1.65%) and proportionately lower among uninsured (1.28%) and non-Medicaid patients. ,” the authors write. .91%)”.

The authors found that black, male, and elderly patients were at increased risk of cardiovascular death. Patients insured through Medicaid had the highest standardized mortality rate (SMR, the percentage of deaths in the study compared to the estimated number of deaths in the general population), and white Medicaid recipients had the highest SMR, at 3.57. (3.87). ) and white patients without Medicaid had the lowest SMR (1.24). Black Medicaid recipients had the lowest comparative SMR when aligned with patients of other races.

“In particular, because nonwhite patients are disproportionately enrolled in Medicaid or uninsured because of their socioeconomic status, this insurance disparity further contributes to racial disparities in health care outcomes and It is feared that this could lead to complications,” the authors wrote. “Furthermore, insurance inequalities in CVD mortality

Indeed, cancer survivors were more prominent compared with all-cause or cancer-specific mortality. This highlights the growing need to pay more attention to cardiac care for cancer survivors, and to achieve quality care to close the current outcome gap. It is justified to work closely with departmental, primary care, and oncology physicians. ”

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