In an analysis reported in JACC: CardioOncology, Cenjing Zhu, MPhil, of the Department of Chronic Disease Epidemiology, Yale University, and colleagues found that Black patients with cancer in the United States were at increased risk of all-cause mortality and cardiovascular (CVD) mortality compared with White patients.¹ 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 or older at initial cancer diagnosis were compared for race and ethnicity groups; the 10 most prevalent cancers (breast, prostate, lung/bronchus, colon/rectum, melanoma of the skin, non-Hodgkin lymphoma, kidney and renal pelvis, corpus uteri, urinary bladder, and larynx) were included in the analysis.

Cenjing Zhu, MPhil

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/Alaska 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 and American Indian/Alaska Native patients (overall P < .001).

In an analysis adjusting for sociodemographic and clinical characteristics, 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/Alaska 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 and those aged 55 or older (P for interaction < .001). Among patients aged 18 to 54, Black patients (HR = 1.33, 95% CI = 1.31–1.36), American Indian/Alaska 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 a 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/Alaska 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, 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 a significantly reduced risk.

Localized Disease Subgroup

In addition to the disparities in outcome among patients aged 18 to 54, disparities were also marked among patients with localized cancer. Among patients with localized disease, the risk for all-cause mortality was significantly higher among Black patients (HR = 1.24, 95% CI = 1.23–1.25) and American Indian/Alaska 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 a 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 a significantly reduced risk.

The investigators concluded: “Significant racial and ethnic differences exist in both all-cause and CVD mortality among U.S. cancer patients. 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.” 

DISCLOSURE: The study authors reported no conflicts of interest. 

REFERENCE

1. Zhu C, Shi T, Jiang C, et al: Racial and ethnic disparities in all-cause and cardiovascular mortality among cancer patients in the U.S. JACC CardioOncol 5:55-66, 2023.