Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
Biomedical Statistics Research Core, University of Vermont, Burlington, VT, USA.
Cancer Epidemiol. 2022 Oct;80:102238. doi: 10.1016/j.canep.2022.102238. Epub 2022 Aug 12.
Clonal hematopoiesis, a precursor to myelodysplastic syndromes (MDS), constitutes a novel cardiovascular disease (CVD) risk factor, causing growing interest in cardiovascular outcomes in MDS. Rurality is associated with increased CVD but studies on cardiovascular geographic disparities in MDS are lacking.
Using the U.S. Surveillance, Epidemiology, and End Results (SEER) registry, we identified 52,750 MDS patients between 2001 and 2016. Rurality was defined using Rural-Urban Continuum Codes. Cox regression estimated the association of rurality and cardiovascular death.
MDS incidence was equal in urban and rural populations (6.7 per 100,000). Crude probability of cardiovascular death was higher among rural MDS patients. Adjusting for age, sex, race/ethnicity, marital status, insurance, and MDS risk (defined from histology), rural patients had 12% increased risk of CVD death compared to urban patients (HR=1.12, 95%CI 1.03-1.21). HR for CVD death was 1.22 (95%CI 1.01-1.5) in patients from the most rural areas (less than 2500 urban population). Among MDS patients younger than 65 years, rurality was associated with 25% increased risk of CVD death (HR=1.25, 95%CI 1.01-1.59).
This population-based analysis suggests that rural residence is linked to higher burden of cardiovascular death in patients with MDS. The disparity is not explained by demographic factors or MDS risk. Interventions targeting CVD may improve outcomes in rural MDS patients.
克隆性造血是骨髓增生异常综合征（MDS）的前身，构成了一种新的心血管疾病（CVD）风险因素，因此人们越来越关注 MDS 的心血管结局。农村地区与 CVD 风险增加相关，但缺乏 MDS 心血管地理差异的研究。
我们使用美国监测、流行病学和最终结果（SEER）登记处，在 2001 年至 2016 年间确定了 52750 名 MDS 患者。农村地区的定义使用农村-城市连续体代码。Cox 回归估计了农村地区与心血管死亡的关联。
城市和农村地区的 MDS 发病率相同（每 10 万人中有 6.7 例）。农村 MDS 患者心血管死亡的粗发生率较高。调整年龄、性别、种族/民族、婚姻状况、保险和 MDS 风险（根据组织学定义）后，与城市患者相比，农村患者 CVD 死亡风险增加 12%（HR=1.12，95%CI 1.03-1.21）。来自最农村地区（少于 2500 名城市人口）的患者 CVD 死亡的 HR 为 1.22（95%CI 1.01-1.5）。在年龄小于 65 岁的 MDS 患者中，农村地区与 CVD 死亡风险增加 25%相关（HR=1.25，95%CI 1.01-1.59）。
这项基于人群的分析表明，农村居民与 MDS 患者心血管死亡负担增加有关。这种差异不能用人口因素或 MDS 风险来解释。针对 CVD 的干预措施可能会改善农村 MDS 患者的结局。
