Cardiovascular Risk Factor Disparities in Adult Survivors of Childhood Cancer Compared With the General Population

David H Noyd; Qi Liu; Yutaka Yasui; Eric J Chow; Smita Bhatia; Paul C Nathan; Andrew P Landstrom; Emily Tonorezos; Jacqueline Casillas; Amy Berkman; Kirsten K Ness; Daniel A Mulrooney; Wendy M Leisenring; Carrie R Howell; Jamie Shoag; Anne Kirchhoff; Rebecca M Howell; Todd M Gibson; Leah L Zullig; Gregory T Armstrong; Kevin C Oeffinger

doi:10.1016/j.jaccao.2023.01.011

Cardiovascular Risk Factor Disparities in Adult Survivors of Childhood Cancer Compared With the General Population

JACC CardioOncol. 2023 Apr 11;5(4):489-500. doi: 10.1016/j.jaccao.2023.01.011. eCollection 2023 Aug.

Authors

David H Noyd^{1

2}, Qi Liu³, Yutaka Yasui^{3

4}, Eric J Chow⁵, Smita Bhatia⁶, Paul C Nathan⁷, Andrew P Landstrom¹, Emily Tonorezos⁸, Jacqueline Casillas⁹, Amy Berkman¹, Kirsten K Ness⁴, Daniel A Mulrooney⁴, Wendy M Leisenring⁵, Carrie R Howell⁶, Jamie Shoag¹⁰, Anne Kirchhoff¹¹, Rebecca M Howell¹², Todd M Gibson⁸, Leah L Zullig^{1

13}, Gregory T Armstrong⁴, Kevin C Oeffinger¹

Affiliations

¹ Duke University Medical Center, Durham, North Carolina, USA.
² The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
³ University of Alberta, Edmonton, Canada.
⁴ St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
⁵ Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
⁶ University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁷ The Hospital for Sick Children, Toronto, Ontario, Canada.
⁸ National Cancer Institute, Rockville, Maryland, USA.
⁹ University of California Los Angeles Medical Center, Los Angeles, California, USA.
¹⁰ Cleveland Clinic, Cleveland, Ohio, USA.
¹¹ University of Utah, Salt Lake City, Utah, USA.
¹² The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹³ Durham Veterans Administration Health Care System, Durham, North Carolina, USA.

Abstract

Background: It is unknown whether a history of childhood cancer modifies the established disparities in cardiovascular risk factors (CVRFs) observed in the general population.

Objectives: We sought to determine if disparities in CVRFs by race/ethnicity are similar among childhood cancer survivors compared with the general population.

Methods: The Childhood Cancer Survivor Study (CCSS) is a retrospective cohort with a longitudinal follow-up of 24,084 5-year survivors diagnosed between 1970 and 1999. Multivariable piecewise exponential regression estimated incidence rate ratios (IRRs) for hypertension, hyperlipidemia, diabetes, obesity, and ≥2 CVRFs by race/ethnicity. The CCSS sibling cohort and the National Health and Nutrition Examination Survey cohort were used to compare the sociodemographic-adjusted IRRs for same-race/same-ethnicity disparities.

Results: Non-Hispanic Black (NHB) (n = 1,092) and Hispanic (n = 1,405) survivors compared with non-Hispanic White (NHW) (n = 13,960) survivors reported a higher cumulative incidence of diabetes (8.4%, 9.7%, and 5.1%, respectively); obesity (47.2%, 48.9%, and 30.2%, respectively); multiple CVRFs (17.7%, 16.6%, and 12.3%, respectively); and, for NHB survivors, hypertension (19.5%, 13.6%, and 14.3%, respectively) by 40 years of age (P < 0.001). Controlling for sociodemographic and treatment factors compared with NHW survivors, IRRs for NHB were increased for hypertension (IRR: 1.4; 95% CI: 1.1-1.8), obesity (IRR: 1.7; 95% CI: 1.4-2.1), and multiple CVRFs (IRR: 1.6; 95% CI: 1.2-2.1). IRRs for Hispanic survivors were increased for diabetes (IRR: 1.8; 95% CI: 1.2-2.6) and obesity (IRR: 1.4; 95% CI: 1.2-1.7). The pattern of IRRs for CVRF differences was similar among CCSS sibling and National Health and Nutrition Examination Survey cohorts.

Conclusions: The higher burden of CVRFs among NHB and Hispanic survivors compared with NHW survivors was similar to the general population. The promotion of cardiovascular health equity is critical in this high-risk population.

Keywords: cardiovascular risk factors; childhood cancer survivors; health equity.

Abstract

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