Duarte Christine W, Lindner Volkhard, Francis Sanjeev A, Schoormans Dounya
Christine W. Duarte, Volkhard Lindner, and Sanjeev A. Francis, Maine Medical Center, Portland, ME; and Dounya Schoormans, Tilburg University, Tilburg, the Netherlands.
JCO Clin Cancer Inform. 2017 Nov;1:1-12. doi: 10.1200/CCI.16.00071.
Cancer and cardiovascular disease (CVD) are common causes of morbidity and mortality, and measurement and interpretation of their co-occurrence rate have important implications for public health and patient care. Here, we present the raw and adjusted co-occurrence rates of cancer and CVD in the overall population by using a visually intuitive network approach.
By using baseline survey and linked health outcome data from 490,842 individuals age 40 to 69 years from the UK Biobank, we recorded diagnoses between 1997 and 2014 of specific cancers and specific CVDs ascertained through hospital claims. We measured raw and adjusted rates of CVD for the following groups: individuals with Hodgkin or non-Hodgkin lymphoma, lung and trachea cancer, uterus cancer, colorectal cancer, prostate cancer, breast cancer, or no recorded diagnosed cancer during this time period. Analysis accounted for age, sex, and behavioral risk factors, without regard to the order of occurrence of cancer and CVD.
A significantly increased rate of CVD was found in patients with multiple types of cancers, including Hodgkin and non-Hodgkin lymphoma and lung and trachea, uterus, colorectal, and breast cancer, compared with patients without cancer by using age and sex-adjusted models. Increased co-occurrence for many CVD categories remained after correction for behavioral risk factors. Construction of co-occurrence networks highlighted heart failure as a shared CVD diagnosis across multiple cancer types, including breast cancer, lung cancer, non-Hodgkin lymphoma, and colorectal cancer. Smoking, physical activity, and other lifestyle factors accounted for some but not all of the increased co-occurrence for many of the CVD diagnoses.
Increased co-occurrence of several common CVD conditions is seen widely across multiple malignancies, and shared diagnoses, such as heart failure, were highlighted by using network methods.
癌症和心血管疾病（CVD）是发病和死亡的常见原因，对其共病率的测量和解释对公共卫生和患者护理具有重要意义。在此，我们通过一种直观的网络方法呈现总体人群中癌症和CVD的原始及校正共病率。
利用英国生物银行490842名40至69岁个体的基线调查和关联的健康结局数据，我们记录了1997年至2014年期间通过医院索赔确定的特定癌症和特定CVD的诊断情况。我们测量了以下几组人群的CVD原始率和校正率：患有霍奇金或非霍奇金淋巴瘤、肺癌和气管癌、子宫癌、结直肠癌、前列腺癌、乳腺癌的个体，或在此期间未记录到确诊癌症的个体。分析考虑了年龄、性别和行为风险因素，而不考虑癌症和CVD的发生顺序。
与无癌症患者相比，在使用年龄和性别校正模型时，发现多种癌症患者（包括霍奇金和非霍奇金淋巴瘤以及肺癌和气管癌、子宫癌、结直肠癌和乳腺癌）的CVD发生率显著增加。校正行为风险因素后，许多CVD类别的共病率仍有所增加。共病网络的构建突出显示心力衰竭是多种癌症类型（包括乳腺癌、肺癌、非霍奇金淋巴瘤和结直肠癌）共有的CVD诊断。吸烟、体育活动和其他生活方式因素在许多CVD诊断中共病率增加中起到了部分但非全部作用。
在多种恶性肿瘤中广泛观察到几种常见CVD情况的共病率增加，并且通过网络方法突出显示了如心力衰竭等共同诊断。
