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Cardiovascular and Cancer Mortality Among Texas Residents With Cancer: A Population-Based Study in Texas
Ted Sohn1, Sola Han1, Won Seog Choi1
1Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
Abstract:
IntroductionCancer 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.MethodsUsing 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.ResultsIn 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).ConclusionsCancer-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.
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