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Racial Disparities in Cardiovascular and Cerebrovascular Adverse Events in Patients with Non-Hodgkin Lymphoma: A
Kanishka Uttam Chandani1, Siddharth Pravin Agrawal2, Maharshi Raval1
1Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI 02895, USA.
Insights
Racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) exist for Non-Hodgkin lymphoma (NHL) patients. Black and Asian/Pacific Islander patients face higher mortality, necessitating race-stratified healthcare strategies.
Area of Science:
- Oncology
- Cardiology
- Health Disparities
Background:
- Non-Hodgkin lymphoma (NHL) is a significant cause of cancer mortality in the US.
- Existing inequalities in advanced care access affect specific patient populations.
- Racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) among NHL patients require investigation.
Purpose of the Study:
- To investigate racial disparities in MACCEs within the Non-Hodgkin lymphoma patient cohort.
- To identify specific cardiovascular and cerebrovascular event risks across different racial groups diagnosed with NHL.
Main Methods:
- Utilized the US National Inpatient Sample database from 2016-2019.
- Identified Non-Hodgkin lymphoma patients using ICD-10 codes.
- Analyzed baseline characteristics, comorbidities, and MACCE outcomes, stratified by patient race.
Main Results:
- Higher all-cause mortality (ACM) observed in Black and Asian/Pacific Islander patients compared to White patients.
- Black patients showed a statistically significant higher risk of sudden cardiac death.
- Lower risks of atrial fibrillation (AF) and acute myocardial infarction (AMI) were noted in Black and Hispanic patients compared to White patients.
Conclusions:
- Significant racial disparities in MACCEs exist among Non-Hodgkin lymphoma patients.
- These disparities are likely multifactorial, underscoring the need for race-stratified healthcare interventions.
- Further research into epigenomic and social determinants of health is crucial for understanding poorer outcomes in Black and Asian/Pacific Islander NHL patients.
Abstract:
Background and Objectives: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. Materials and Methods: Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016-2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient's race. Results: Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17-1.38, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12-1.45, p < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52-2.16, p < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60-0.81, p < 0.001), Hispanic patients (0.69, 95% CI 0.59-0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43-0.75, p < 0.001) as compared to White patients. Conclusions: Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative.
