Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory of Compound Chinese Medicines, The Ministry of Education Key Laboratory for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
JMIR Public Health Surveill. 2023 Oct 17;9:e40149. doi: 10.2196/40149.
With population aging, the prevalence of both cancer and atrial fibrillation (AF) have increased. However, there is scarce epidemiological data concerning the comorbid state of cancer and AF in low- and middle-income countries, including China.
We aimed to evaluate the site-, sex-, and age-specific profiles of cancer and AF comorbidities in Chinese populations.
Data from the Shanghai Municipal Health Commission database between 2015 and 2020 were screened, covering all medical records of Shanghai residents with medical insurance. Site-specific cancer profiles were evaluated for the population with AF relative to the age- and sex-adjusted population of residents without AF. The sex distribution and peak age of cancer diagnosis were also assessed.
A total of 25,964,447 adult patients were screened. Among them, 22,185 patients presented cancers comorbid with AF (median 77, IQR 67-82 years of age; men: n=13,631, 61.44%), while 839,864 presented cancers without AF (median 67, IQR 57-72 years of age; men: n=419,020, 49.89%), thus yielding a higher cancer prevalence among residents with AF (8.27%) than among those without AF (6.05%; P<.001). In the population with AF, the most prevalent cancer type was lung cancer, followed by colorectal, male genital organ, stomach, breast, liver, bladder, thyroid, leukemia, and esophageal cancers. AF was associated with an average of nearly 1.4-fold (prevalence ratio [PR] 1.37, 95% CI 1.35-1.38) increased prevalence of cancer after adjusting for age and sex. For site-specific analyses, an increased prevalence of cancer in the population with AF was observed in 20 of 21 cancer sites. This increased prevalence was most prominent for nonsolid tumors, including multiple myeloma (PR 2.56, 95% CI 2.28-2.87), leukemia (PR 1.73, 95% CI 1.57-1.90), and non-Hodgkin lymphoma (PR 1.59, 95% CI 1.43-1.77); intrathoracic malignancies, including mediastinum (PR 2.34, 95% CI 1.89-2.90), lung (PR 1.64, 95% CI 1.59-1.69), and esophageal cancers (PR 1.41, 95% CI 1.28-1.56); bone and soft tissue neoplasms (PR 1.56, 95% CI 1.37-1.77); and kidney cancer (PR 1.53, 95% CI 1.36-1.72). Cancer prevalence in the population with AF relative to that in the population without AF was higher in men than in women in 14 of 18 cancer sites, and female predominance was only observed for thyroid cancer. The peak age of index cancer diagnosis was lower in the population with AF (age group: 70-74 years) than in that without AF (age group: 75-79 years), especially for specific cancer types, including thyroid, central nervous system, mediastinum, esophageal, bladder, and biliary cancers.
Patients with AF are associated with increased prevalence, heightened male predominance, and younger peak age of cancer. Further studies are needed to determine whether early screening of specific cancers is cost-effective and beneficial for patients with AF.
随着人口老龄化，癌症和心房颤动（AF）的患病率都有所增加。然而，在包括中国在内的中低收入国家，关于癌症和 AF 合并症的流行病学数据仍然稀缺。
我们旨在评估中国人群中癌症和 AF 合并症的部位、性别和年龄特征。
我们筛选了 2015 年至 2020 年期间上海市卫生委员会数据库中的数据，涵盖了所有有医疗保险的上海居民的医疗记录。相对于没有 AF 的居民的年龄和性别调整人口，评估了有 AF 的人群中特定部位的癌症情况。还评估了癌症的性别分布和发病高峰年龄。
共筛选出 25964447 名成年患者。其中，22185 名患者患有癌症合并 AF（中位数 77 岁，IQR 67-82 岁；男性：n=13631，61.44%），而 839864 名患者患有癌症但没有 AF（中位数 67 岁，IQR 57-72 岁；男性：n=419020，49.89%），因此有 AF 的居民中癌症的患病率（8.27%）高于没有 AF 的居民（6.05%；P<.001）。在有 AF 的人群中，最常见的癌症类型是肺癌，其次是结直肠癌、男性生殖器官癌、胃癌、乳腺癌、肝癌、膀胱癌、甲状腺癌、白血病和食管癌。AF 与癌症的平均患病率增加近 1.4 倍（患病率比 [PR] 1.37，95%置信区间 [CI] 1.35-1.38），校正年龄和性别后。对于特定部位的分析，在 21 个癌症部位中有 20 个部位有 AF 的人群中癌症的患病率增加。这种患病率的增加在非实体瘤中最为明显，包括多发性骨髓瘤（PR 2.56，95%CI 2.28-2.87）、白血病（PR 1.73，95%CI 1.57-1.90）和非霍奇金淋巴瘤（PR 1.59，95%CI 1.43-1.77）；胸部恶性肿瘤，包括纵隔（PR 2.34，95%CI 1.89-2.90）、肺（PR 1.64，95%CI 1.59-1.69）和食管癌（PR 1.41，95%CI 1.28-1.56）；骨和软组织肿瘤（PR 1.56，95%CI 1.37-1.77）；和肾癌（PR 1.53，95%CI 1.36-1.72）。在 18 个癌症部位中有 14 个部位，有 AF 的人群与没有 AF 的人群相比，癌症的患病率在男性中更高，而在女性中仅观察到甲状腺癌的患病率更高。AF 人群中癌症的发病高峰年龄（年龄组：70-74 岁）低于没有 AF 的人群（年龄组：75-79 岁），特别是对于特定的癌症类型，包括甲状腺、中枢神经系统、纵隔、食管、膀胱和胆道癌。
AF 患者的癌症患病率更高，男性患病率更高，发病高峰年龄更低。需要进一步研究以确定针对 AF 患者进行特定癌症的早期筛查是否具有成本效益和益处。
