In an analysis reported in JACC: CardioOncology, Zhu et al found that in the United States, Black patients with cancer were at increased risk of all-cause mortality and cardiovascular (CVD) mortality compared with White patients, and that White patients were at increased risk of both outcomes compared with Hispanic and Asian/Pacific Islander patients.

Study Details

The study involved data from the Surveillance, Epidemiology, and End Results database from 2000 to 2018. All-cause and CVD mortality among patients aged ≥ 18 years at initial cancer diagnosis were compared for race and ethnicity groups; the 10 most prevalent cancers (breast, prostate, lung/bronchus, colorectal, melanoma of the skin, non-Hodgkin lymphoma, kidney and renal pelvis, uterine, bladder, and laryngeal) were included in the analysis.

All-Cause Mortality

Among the 3,674,511 patients included in the analysis, 73.6% were White, 11.0% were Black, 9.0% were Hispanic, 6.1% were Asian/Pacific Islander, and 0.4% were American Indian/Alaskan Native. A total of 1,644,067 patients (44.7%) died, with 231,386 (6.3%) deaths attributable to CVD.

In the entire cohort, median overall survival was 4.8 years, including 4.9 years among White patients, 4.6 years among Asian/Pacific Islander patients, 4.5 years among Hispanic patients, and 4.2 years among Black patients and American Indian/Alaskan Native patients (overall P < .001).

In analysis adjusting for sociodemographic and clinical characteristics, a significantly increased risk for all-cause mortality was observed among Black patients (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 1.14–1.15) and American Indian/Alaskan Native patients (HR = 1.10, 95% CI = 1.08–1.13) vs White patients. Hispanic patients (HR = 0.98, 95% CI = 0.97–0.99) and Asian/Pacific Islander patients (HR = 0.85, 95% CI = 0.84–0.85) had a reduced risk of all-cause mortality vs White patients.

The association between race and ethnicity and all-cause mortality differed between patients aged 18 to 54 years and those aged ≥ 55 years (P for interaction < .001). Among patients aged 18 to 54 years, Black patients (HR = 1.33, 95% CI = 1.31–1.36), American Indian/Alaskan Native patients (HR = 1.25, 95% CI = 1.15–1.35), and Hispanic patients (HR = 1.11, 95% CI = 1.09–1.13) were at increased risk vs White patients, whereas Asian/Pacific Islander patients were at reduced risk (HR = 0.91, 95% CI = 0.89–0.94).

CVD Mortality

In an analysis adjusting for sociodemographic and clinical characteristics, Black patients had a significantly increased risk for CVD death (HR = 1.25, 95% CI = 1.23–1.27) vs White patients. Compared with White patients, risks were significantly lower among Hispanic patients (HR = 0.81, 95% CI = 0.79–0.82) and Asian/Pacific Islander patients (HR = 0.78, 95% CI = 0.78–0.80), and numerically lower among American Indian/Alaskan Native patients (HR = 0.95, 95% CI = 0.89–1.03). 

As with all-cause mortality, the interaction between race and ethnicity and age group was significant (P for interaction < .001). Among patients aged 18 to 54 years, Black patients were at a significantly increased risk of CVD mortality (HR = 1.76, 95% CI = 1.67–1.85) vs White patients; compared with White patients, Hispanic patients (HR = 0.79, 95% CI = 0.73-–0.85) and Asian/Pacific Islander patients (HR = 0.85, 95% CI = 0.77­–0.95) had significantly reduced risk.

Localized Disease Subgroup

In addition to the disparities in outcomes among patients aged 18 to 54 years, disparities were also marked among patients with localized cancer. Among patients with localized disease, risk for all-cause mortality was significantly higher among Black patients (HR = 1.24, 95% CI = 1.23–1.25) and American Indian/Alaskan Native patients (HR = 1.21, 95% CI = 1.16–1.26) compared with White patients, whereas Asian/Pacific Islander patients (HR = 0.82, 95% CI = 0.81–0.83) and Hispanic patients (HR = 0.95, 95% CI = 0.94–0.96) had significantly reduced risk. Risk for CVD mortality was significantly increased among Black patients (HR = 1.25, 95% CI = 1.23–1.27) vs White patients, whereas Asian/Pacific Islander patients (HR = 0.76, 95% CI = 0.74–0.78) and Hispanic patients (HR = 0.81, 95% CI = 0.79-0.82) had significantly reduced risk.

The investigators concluded, “Significant racial and ethnic differences exist in both all-cause and CVD mortality among U.S. [patients with] cancer. Our findings underscore the vital roles of accessible cardiovascular interventions and strategies to identify high-risk cancer populations who may benefit most from early and long-term survivorship care.”

Stuart Zarich, MD, of the Division of Cardiovascular Medicine, Bridgeport Hospital, Yale New Haven Health System, is the corresponding author for the JACC: CardioOncology article.

Disclosure: For full disclosures of the study authors, visit jacc.org.