Mahmoud Heba T, Berton Giuseppe, Cordiano Rocco, Palmieri Rosa, Nardi Tobia, Abdel-Wahab Mohammad Ak, Cavuto Fiorella
The ABC Heart Disease Foundation-Organizzazione Non Lucrativa di Utilità Sociale (ONLUS), Conegliano, Italy.
Department of Cardiology, Conegliano General Hospital, Conegliano, Italy.
Front Oncol. 2021 Oct 14;11:731249. doi: 10.3389/fonc.2021.731249. eCollection 2021.
An increased risk of cancer death has been demonstrated for patients diagnosed with acute coronary syndrome (ACS). We are investigating possible geographic risk disparities.
This prospective study included 541 ACS patients who were admitted to hospitals and discharged alive in three provinces of Italy's Veneto region. The patients were classified as residing in urban or rural areas in each province.
With 3 exceptions, all patients completed the 22-year follow-up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre-existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow-up period, which represented 6232 person-years. No difference in the cancer death risk was found between the urban and rural areas or between southern and northern provinces (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.7-1.7; = 0.59 and HR 1.1; 95% CI 0.9-1.4; = 0.29, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 1.9; 95% CI 1.1-3.0; = 0.01). The fully adjusted Cox regression and Fine-Gray competing risk regression models provided similar results. Interestingly, these results persisted, and even strengthened, after exclusion of the 22 patients who developed malignancy and survived to the end of follow-up. We did not observe an urban/rural difference in non-neoplastic death risk or a significant interaction between the geographic areas.
Our analysis reveals that the cancer death risk among unselected ACS patients in Italy's Veneto region significantly differs by geography. The northern rural area has the highest risk. These results highlight the importance of implementing a preventive policy based on area-specific knowledge.
已证实，被诊断为急性冠状动脉综合征（ACS）的患者癌症死亡风险增加。我们正在调查可能存在的地理风险差异。
这项前瞻性研究纳入了意大利威尼托地区三个省份住院并存活出院的541例ACS患者。患者被分类为各省份的城市或农村居民。
除3例患者外，所有患者均完成了22年的随访或被随访至死亡。城市（46%）和农村（54%）居民的大多数基线人口统计学和临床特征相同。15例患者存在既往恶性肿瘤，而106例患者在随访期间发生癌症，随访人年数为6232人年。根据未调整的Cox回归分析，城市和农村地区之间或南部和北部省份之间的癌症死亡风险没有差异（风险比[HR]1.1；95%置信区间[CI]0.7 - 1.7；P = 0.59和HR 1.1；95% CI 0.9 - 1.4；P = 0.29）。然而，地理区域显示出强烈的正交互作用，从南部省份到北部省份，风险从城市到农村地区增加（HR 1.9；95% CI 1.1 - 3.0；P = 0.01）。完全调整的Cox回归和Fine - Gray竞争风险回归模型提供了相似的结果。有趣的是，在排除22例发生恶性肿瘤并存活至随访结束的患者后，这些结果仍然存在，甚至有所加强。我们没有观察到非肿瘤性死亡风险的城乡差异或地理区域之间的显著交互作用。
我们的分析表明，意大利威尼托地区未选择的ACS患者的癌症死亡风险因地理位置而异。北部农村地区风险最高。这些结果凸显了基于特定区域知识实施预防政策的重要性。
