Noyd David H, Liu Qi, Yasui Yutaka, Chow Eric J, Bhatia Smita, Nathan Paul C, Landstrom Andrew P, Tonorezos Emily, Casillas Jacqueline, Berkman Amy, Ness Kirsten K, Mulrooney Daniel A, Leisenring Wendy M, Howell Carrie R, Shoag Jamie, Kirchhoff Anne, Howell Rebecca M, Gibson Todd M, Zullig Leah L, Armstrong Gregory T, Oeffinger Kevin C
Duke University Medical Center, Durham, North Carolina, USA.
The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
JACC CardioOncol. 2023 Apr 11;5(4):489-500. doi: 10.1016/j.jaccao.2023.01.011. eCollection 2023 Aug.
It is unknown whether a history of childhood cancer modifies the established disparities in cardiovascular risk factors (CVRFs) observed in the general population.
We sought to determine if disparities in CVRFs by race/ethnicity are similar among childhood cancer survivors compared with the general population.
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.
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 ( 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.
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.
儿童癌症病史是否会改变普通人群中已观察到的心血管危险因素（CVRF）方面的既定差异尚不清楚。
我们试图确定与普通人群相比，儿童癌症幸存者中按种族/族裔划分的CVRF差异是否相似。
儿童癌症幸存者研究（CCSS）是一项回顾性队列研究，对1970年至1999年间确诊的24,084名5年幸存者进行了纵向随访。多变量分段指数回归估计了按种族/族裔划分的高血压、高脂血症、糖尿病、肥胖症以及≥2种CVRF的发病率比（IRR）。使用CCSS同胞队列和国家健康与营养检查调查队列来比较同种族/同族裔差异的社会人口统计学调整后的IRR。
与非西班牙裔白人（NHW）（n = 13,960）幸存者相比，非裔美国人（NHB）（n = 1,092）和西班牙裔（n = 1,405）幸存者报告的糖尿病累积发病率更高（分别为8.4%、9.7%和5.1%）；肥胖症（分别为47.2%、48.9%和30.2%）；多种CVRF（分别为17.7%、16.6%和12.3%）；对于NHB幸存者，40岁时高血压累积发病率也更高（分别为19.5%、13.6%和14.3%）（P < 0.001）。与NHW幸存者相比，在控制社会人口统计学和治疗因素后，NHB在高血压（IRR：1.4；95%CI：1.1 - 1.8）、肥胖症（IRR：1.7；95%CI：1.4 - 2.1）和多种CVRF（IRR：1.6；95%CI：1.2 - 2.1）方面的IRR升高。西班牙裔幸存者在糖尿病（IRR：1.8；95%CI：1.2 - 2.6）和肥胖症（IRR：1.4；95%CI：1.2 - 1.7）方面的IRR升高。CCSS同胞队列和国家健康与营养检查调查队列中CVRF差异的IRR模式相似。
与NHW幸存者相比，NHB和西班牙裔幸存者中CVRF负担较高的情况与普通人群相似。在这个高危人群中促进心血管健康公平至关重要。
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