Cardiovascular Mortality Risk After Cancer Diagnosis by County-Level Characteristics in the United States 2000-2021

Area of Science:

• Cardio-oncology
• Cancer survivorship
• Public health

Background:

• Cardiovascular disease (CVD) is the leading non-cancer cause of death in cancer survivors.
• Access to specialized cardio-oncology care is limited, particularly outside urban centers.

Purpose of the Study:

• To investigate CVD mortality disparities among cancer survivors based on county-level socioeconomic and racial factors.
• To identify specific cancer types with the greatest CVD mortality disparities.

Main Methods:

• Retrospective cohort study using SEER 17 Registries (2000-2021) of 6,467,098 individuals.
• Analysis of CVD-specific mortality by county-level urban/rural status, persistent poverty, and racial composition.
• Cancer-specific analyses to assess heterogeneity in county-level disparities.

Main Results:

• Cancer survivors had significantly higher CVD mortality (SMR=1.11).
• Elevated CVD mortality was observed in rural counties (SMR=1.27), counties with persistent poverty (SMR=1.35), and areas with high Black populations (SMR=1.15).
• The highest risk was in rural counties with persistent poverty (SMR=1.53), with disparities persisting over a decade.

Conclusions:

• Cancer survivors face substantial, sustained excess CVD mortality, with greatest disparities in rural, impoverished counties.
• There is a critical need to integrate cardiovascular surveillance into cancer survivorship care.
• Expanding cardio-oncology services in socially vulnerable communities is essential to mitigate these risks.