1999 - 2020年美国乳腺癌患者的心血管死亡率趋势及差异：一项基于人群的回顾性研究

Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999-2020: a population-based retrospective study.

作者信息

Yeo Yong-Hao, San Boon-Jian, Tan Jia-Yi, Tan Min-Choon, Donisan Teodora, Lee Justin Z, Franey Laura M, Hayek Salim S

机构信息

Department of Internal Medicine/ Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.

Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.

出版信息

Cardiooncology. 2024 Dec 19;10(1):89. doi: 10.1186/s40959-024-00286-2.

DOI:10.1186/s40959-024-00286-2

PMID:39696722

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11658079/

Abstract

BACKGROUND

Breast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.

OBJECTIVE

To investigate trends and disparities in CVD mortality among breast cancer patients.

METHODS

We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.

RESULTS

A total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50-2.65]) in 1999 to 1.20 (95% CI [1.15-1.24]) in 2020, with an average annual percent change (AAPC) of - 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90-1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72-0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62-1.67] vs. 1.55, 95%CI [1.53-1.56]).

CONCLUSION

The study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.

摘要

背景

与非乳腺癌患者相比，乳腺癌幸存者面临更高的心血管疾病（CVD）风险，但该群体中与CVD相关死亡率的当代数据仍然稀缺。

目的

调查乳腺癌患者中CVD死亡率的趋势和差异。

方法

我们查询了疾病控制与预防中心的广泛在线流行病学研究数据（CDC Wonder），并对1999年至2020年25岁及以上乳腺癌患者CVD死亡率的国家死亡证明数据进行了系列横断面分析。我们计算了每10万人的年龄调整死亡率（AAMR），并使用Joinpoint回归程序分析随时间的趋势，进一步按年龄、种族、人口普查区域和城市化水平进行分层分析。

结果

1999年至2020年期间，美国共确定了74733例合并乳腺癌的CVD病例。合并乳腺癌的CVD的AAMR从1999年的2.57（95%CI[2.50 - 2.65]）降至2020年的1.20（95%CI[1.15 - 1.24]），平均年变化百分比（AAPC）为-4.3。CVD的三个最常见病因是缺血性心脏病（47.8%）、脑血管疾病（17.1%）和高血压疾病（10.6%）。我们的分析显示，除高血压疾病和心律失常外，所有CVD亚型的AAMR均显著下降。与年龄<65岁的个体相比，年龄≥65岁的个体年变化百分比（APC）的下降更为明显（分别为-4.4，95%CI[-4.9，-3.9]和-2.9，95%CI[-4.1，-1.7]）。值得注意的是，非西班牙裔黑人始终表现出最高的AAMR（1.95，95%CI[1.90 - 1.99]），而西班牙裔或拉丁裔患者的AAMR最低（0.75，95%CI[0.72 - 0.78]）。农村地区的AAMR也高于城市地区（1.64，95%CI[1.62 - 1.67]与1.55，95%CI[1.53 - 1.56]）。