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Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999-2020: a population-based
Yong-Hao Yeo1, Boon-Jian San2, Jia-Yi Tan3
1Department of Internal Medicine/ Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA. yeo.yonghao.96@gmail.com.
Insights
Cardiovascular disease (CVD) mortality in breast cancer patients significantly decreased by over 50% from 1999 to 2020. However, disparities in CVD mortality persist among different racial groups and regions.
Area of Science:
- Oncology
- Cardiology
- Public Health
- Epidemiology
Background:
- Breast cancer survivors have an elevated risk of cardiovascular disease (CVD).
- Contemporary data on CVD mortality in this population is limited.
Purpose of the Study:
- To examine trends and disparities in CVD mortality among breast cancer patients in the United States.
- To analyze CVD mortality rates stratified by demographic and geographic factors.
Main Methods:
- Utilized national death certificate data from CDC Wonder (1999-2020).
- Conducted serial cross-sectional analyses of age-adjusted mortality rates (AAMR) for breast cancer patients aged 25+.
- Analyzed trends using Joinpoint Regression, stratifying by age, race, region, and urbanization.
Main Results:
- Identified 74,733 deaths from CVD with comorbid breast cancer.
- Overall AAMR decreased from 2.57 in 1999 to 1.20 in 2020 (AAPC of -4.3%).
- Significant declines observed across most CVD subtypes, except hypertensive diseases and arrhythmias. Non-Hispanic Black patients and those in rural areas showed higher AAMR.
Conclusions:
- A substantial reduction in CVD mortality among breast cancer patients occurred over two decades.
- Persistent racial and regional disparities in CVD mortality remain a concern.
- Hypertensive diseases and arrhythmias represent exceptions to the overall declining trend in CVD mortality.
Background:
Breast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.
Objective:
To investigate trends and disparities in CVD mortality among breast cancer patients.
Methods:
We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.
Results:
A total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50-2.65]) in 1999 to 1.20 (95% CI [1.15-1.24]) in 2020, with an average annual percent change (AAPC) of - 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90-1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72-0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62-1.67] vs. 1.55, 95%CI [1.53-1.56]).
Conclusion:
The study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.
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