Sarju Ganatra, MD
In a U.S.-based cross-sectional study reported in JACC: CardioOncology, Sarju Ganatra, MD, of Lahey Hospital & Medical Center, Burlington, Massachusetts, and colleagues found that mortality from comorbid cancer and cardiovascular disease (CVD) was significantly higher in counties with higher vs lower social vulnerability.1
Study Details
The study used the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research database for 2015 to 2019 to obtain county-level data on mortality attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index data for 2014 to 2018 from the CDC Agency for Toxic Substances and Disease Registry were used to generate social vulnerability index percentiles and quartiles (lower quartile = lower social vulnerability). Age-adjusted mortality rates for 2015 to 2019 were estimated and analyzed according to social vulnerability index quartiles.
Age-Adjusted Mortality Rates for Cancer, CVD, and Comorbid Cancer and CVD
The overall age-adjusted mortality rate for cancer was 167.80 (95% confidence interval [CI] = 167.62–167.99) per 100,000 person-years. Age-adjusted mortality rates per 100,000 person years was lowest in the first social vulnerability index quartile (160.11, 95% CI = 159.69–160.52) and highest in the fourth social vulnerability index quartile (174.09, 95% CI = 173.70–174.49); the difference yielded an excess of 13.98 deaths per 100,000 person-years for the fourth vs first quartiles (rate ratio [RR] for fourth vs first quartile = 1.087, 95% CI = 1.084–1.091).
The overall age-adjusted mortality rate for CVD was 386.01 (95% CI = 385.73–386.29) per 100,000 person-years. Age-adjusted mortality rates per 100,000 person years were lowest in the first quartile (344.25, 95% CI = 343.63–344.86) and highest in the fourth quartile (443.13, 95% CI = 442.49–443.77); the difference yielded an excess of 98.88 deaths per 100,000 person-years in the fourth vs first quartiles (RR = 1.287, 95% CI = 1.284–1.290).
The overall age-adjusted mortality rates for comorbid cancer and CVD was 47.75 (95% CI = 47.66–47.85) per 100,000 person-years. Age-adjusted mortality rates per 100,000 person-years were lowest in the first quartile (43.47, 95% CI = 43.25–43.69) and highest in the fourth quartile (58.25, 95% CI = 58.02–58.48); the difference yielded an excess of 10.5 deaths per 100,000 person-years in the fourth vs first quartile (RR = 1.34, 95% CI = 1.33–1.35). This rate ratio was significantly greater than those observed for age-adjusted mortality rates for cancer alone (P < .001) or CVD alone (P < .001).
Analysis by Race in Lowest Social Vulnerability Index Quartile
In a sensitivity analysis by race within the fourth social vulnerability index quartile, with White persons as the reference group, only Black persons had significantly greater rate ratios for cancer mortality (1.139, 95% CI = 1.132–1.146), CVD mortality (1.230, 95% CI = 1.225–1.234), and comorbid cancer and CVD mortality (1.142, 95% CI = 1.131–1.154).
Groups With Comorbid Cancer and CVD With Greatest Relative Increases in Risk
According to age, sex, race, and ethnicity, the groups with the greatest relative increases in mortality from comorbid cancer and CVD between the first and fourth social vulnerability index quartiles compared with their counterparts were adults up to age 45 (RR = 2.02, 95% CI = 1.92–2.12), women (RR = 1.36, 95% CI = 1.34–1.37), Asian/Pacific Islanders (RR = 2.17, 95% CI = 2.08–2.26), and Hispanic persons (RR = 1.22, 95% CI = 1.21–1.23). No marked differences in rate ratios according to urban or rural status were observed.
KEY POINTS
- Mortality rates due to cancer, cardiovascular disease (CVD), and comorbid cancer and CVD increased from the lowest to highest social vulnerability index quartiles.
- The increase in risk from lowest to highest quartile was significantly greater with comorbid cancer and CVD vs cancer alone and CVD alone.
The investigators concluded: “Our large population-based study of U.S. adults demonstrates, for the first time, the graded increase in county-level mortality secondary to comorbid cancer and CVD with greater social vulnerability. The incremental impact of social vulnerability was higher for mortality related to comorbid cancer and CVD than for mortality related to either cancer or CVD alone. Additionally, we found that adults < 45 years of age, women, Asian and Pacific Islanders, and Hispanics had a higher relative increase in mortality related to comorbid cancer and CVD when comparing populations with the least…and most…social vulnerability…. Last, among those with the greatest social vulnerability…, Black individuals had significantly higher age-adjusted mortality rates secondary to cancer, CVD, and comorbid cancer and CVD compared with White individuals. These findings emphasize the impact of social vulnerability and race/ethnicity on mortality related to comorbid cancer and CVD and highlight populations that would benefit from targeted public health and policy interventions.”
DISCLOSURE: The study was supported by the National Cancer Institute, Catherine Fitch Fund, and Gelb Master Clinician Fund at Brigham and Women’s Hospital. For full disclosures of the study authors, visit jacc.org.
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