Division of Urology, University of Utah, Salt Lake City, UT.
Division of Urology, University of Utah, Salt Lake City, UT.
Urol Oncol. 2023 Oct;41(10):429.e15-429.e23. doi: 10.1016/j.urolonc.2023.06.008. Epub 2023 Jul 16.
Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship.
Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years.
Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008).
This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.
前列腺癌生存和心血管疾病的农村差异仍然存在。前列腺癌治疗也会导致心血管疾病结局恶化。我们的目的是确定心血管结局的城乡差异是否导致前列腺癌生存差异。
数据来自犹他州人口数据库。通过诊断年份和年龄对农村和城市前列腺癌幸存者进行匹配。使用 Cox 比例风险模型，根据城乡分类，估计心血管疾病（1-3 级）的风险比，同时控制人口统计学和社会经济特征。我们确定了 3379 名农村和 16253 名城市前列腺癌幸存者，中位随访时间为 9.3 年。
结果表明，农村幸存者患高血压（HR0.90）、动脉疾病（HR0.92）和静脉疾病（HR0.92）的风险较低，但充血性心力衰竭（HR1.17）的风险较高。2 级心血管疾病与城乡状况之间的相互作用表明，所有原因（P=0.005）和癌症特异性死亡率（P=0.008）的心脏病具有明显的组间关系。
本研究揭示了城乡状况、心血管疾病和前列腺癌之间的复杂关系。农村幸存者被诊断为筛查发现的心血管疾病的可能性较低，但心力衰竭的可能性较高。此外，心血管疾病与生存之间的关系在农村和城市幸存者之间存在差异。这可能表明我们的发现强调了医疗保健获取方面的差异，农村患者不太可能接受可预防的心血管疾病筛查，并且在发生重大心血管事件时预后更差。
