Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study

被引:45
作者
Keegan, Theresa H. M. [1 ,2 ,3 ]
Kushi, Lawrence H. [4 ]
Li, Qian [1 ,2 ]
Brunson, Ann [1 ,2 ]
Chawla, X. [4 ,5 ]
Chew, Helen K. [1 ,2 ]
Malogolowkin, Marcio [6 ]
Wun, Ted [1 ,2 ]
机构
[1] Univ Calif Davis, Sch Med, COHORT, Sacramento, CA 95817 USA
[2] Univ Calif Davis, Sch Med, Div Hematol & Oncol, Sacramento, CA 95817 USA
[3] Univ Calif Davis, Comprehens Canc Ctr, Div Hematol & Oncol, 4501 X St,Suite 3016, Sacramento, CA 95817 USA
[4] Kaiser Permanente Northern Calif, Div Res, Oakland, CA USA
[5] VA Greater Los Angeles Healthcare Syst, VA HSR&D Ctr Study Healthcare Innovat Implementat, Los Angeles, CA USA
[6] Univ Calif Davis, Sch Med, Dept Pediat, Sacramento, CA 95817 USA
关键词
Cancer; Cardiovascular diseases; Insurance; Adolescent; Young adult; Race/ethnicity; Socioeconomic factors; LONG-TERM SURVIVORS; SOCIOECONOMIC-STATUS; HODGKIN LYMPHOMA; HEALTH-INSURANCE; 5-YEAR SURVIVORS; BREAST-CANCER; RISK-FACTORS; DISPARITIES; CARE; CALIFORNIA;
D O I
10.1007/s11764-018-0678-8
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15-39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors. Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996-2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality. Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33-1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61-1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD. While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors. The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.
引用
收藏
页码:388 / 397
页数:10
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