TY - JOUR
T1 - Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States
AU - Ganatra, Sarju
AU - Dani, Sourbha S.
AU - Kumar, Ashish
AU - Khan, Safi U.
AU - Wadhera, Rishi
AU - Neilan, Tomas G.
AU - Thavendiranathan, Paaladinesh
AU - Barac, Ana
AU - Hermann, Joerg
AU - Leja, Monika
AU - Deswal, Anita
AU - Fradley, Michael
AU - Liu, Jennifer E.
AU - Sadler, Diego
AU - Asnani, Aarti
AU - Baldassarre, Lauren A.
AU - Gupta, Dipti
AU - Yang, Eric
AU - Guha, Avirup
AU - Brown, Sherry Ann
AU - Stevens, Jennifer
AU - Hayek, Salim S.
AU - Porter, Charles
AU - Kalra, Ankur
AU - Baron, Suzanne J.
AU - Ky, Bonnie
AU - Virani, Salim S.
AU - Kazi, Dhruv
AU - Nasir, Khurram
AU - Nohria, Anju
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/9
Y1 - 2022/9
N2 - Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
AB - Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
KW - disparities
KW - epidemiology
KW - risk factor
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U2 - 10.1016/j.jaccao.2022.06.005
DO - 10.1016/j.jaccao.2022.06.005
M3 - Article
AN - SCOPUS:85137876651
SN - 2666-0873
VL - 4
SP - 326
EP - 337
JO - JACC: CardioOncology
JF - JACC: CardioOncology
IS - 3
ER -