Cardiovascular and Cancer Mortality Among Texas Residents With Cancer: A Population-Based Study in Texas
Ted Sohn, Sola Han, Won Seog Choi, Chanhyun ParkIntroduction
Cancer and cardiovascular disease (CVD) are leading causes of death among Texas residents. While advances in cancer treatment have increased survival, long-term survivors face elevated CVD risk. We examined temporal trends in cancer- and CVD-related incidence-based mortality (IBM) rates among Texas residents diagnosed with cancer by cancer stage, primary site, and county, and associations between the CVD-to-cancer IBM ratio and survival.
Methods
Using Texas Cancer Registry data, this retrospective cohort study calculated cancer- and CVD-related IBM rates overall and by stage and the five sites with the highest cancer- and CVD-related deaths, and assessed annual percentage change (APC) using Joinpoint regression. County-level heatmaps displayed cumulative IBM rates and CVD-to-cancer IBM ratios, defined as CVD-related IBM rate divided by cancer-related IBM rate, by these groupings. Weighted Pearson correlations with bootstrap standard errors examined associations between CVD-to-cancer IBM ratios and 1- and 5-year survival among patients diagnosed during 2010-2015, followed through 2020.
Results
In 2010-2019, cancer-related IBM rates declined (APC = -2.51%, 95% CI -3.02 to -2.01, p < 0.001), while CVD-related IBM rates increased (APC = +1.87%, 95% CI 0.81-2.93, p < 0.001). Cancer-related IBM rates decreased, and CVD-related IBM rates generally increased across localized, regional, and distant-stage groups. CVD-to-cancer IBM ratios were higher for high-survival cancers including prostate and breast cancers. Across stages (n=4), correlations between CVD-to-cancer IBM ratio and survival were r = 0.81 (1-year) and r = 0.86 (5-year); inferential statistics were unobtainable. Across sites (n=29), correlations were r = 0.86 (5-year; 95% CI 0.80-0.93, p < 0.001) and r = 0.81 (1-year; 95% CI 0.74-0.89, p < 0.001).
Conclusions
Cancer-related IBM rates declined while CVD-related IBM rates increased, especially in localized-stage, high-survival sites, and specific Texas counties. Incorporating cardiovascular risk assessment and prevention early in cancer care, focusing on underserved areas, may improve long-term survival.