Lim Ghee Kheng, Mee Xuan Ci, Ibrahim Ramzi, Pham Hoang Nhat, Abdelnabi Mahmoud, Pathangey Girish, Bcharah George, Kanaan Christopher, Larsen Carolyn, Ayoub Chadi, Lee Kwan
Author Affiliations: Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona (Drs Lim, Mee, Ibrahim, Abdelnabi, Pathangey, Kanaan, Larsen, Ayoub, Lee); Department of Medicine, University of Arizona Tucson, Tucson, Arizona (Dr Pham); and Mayo Clinic Alix School of Medicine, Phoenix, Arizona (Mr Bcharah).
J Public Health Manag Pract. 2025;31(5):755-762. doi: 10.1097/PHH.0000000000002173. Epub 2025 Jul 17.
Cardiovascular death (CVD) is a leading cause of mortality in patients with cancer, with sociodemographic factors such as urbanization influencing outcomes.
To examine the impact of county-level urbanization on CVD mortality in patients with cancer in the United States from 1999 to 2020.
Retrospective cross-sectional analysis using CDC WONDER mortality data.
US counties categorized as rural or urban based on the 2013 NCHS Urban-Rural Classification Scheme.
Patients with cardiovascular disease (ICD-10: I00-I78) and comorbid cancer (ICD-10: C00-C97), spanning all U.S. counties from 1999 to 2020.
Age-adjusted mortality rates (AAMRs) per 100 000 population and rural-to-urban rate ratios (RRs) with 95% confidence intervals.
The cumulative rural-to-urban RR for CVD in patients with cancer was 1.11 (95% CI: 1.10-1.11), increasing from 1.00 in 1999 to 1.20 in 2020 (β = 0.009, P < .001). Rural AAMRs were higher across demographic groups, including males (12.85 vs 11.62 per 100 000), females (6.08 vs 5.58), Black individuals (9.76 vs 9.64), and White individuals (8.79 vs 7.94). Rural Black populations showed a rising RR from 0.85 in 1999 to 1.04 in 2020 (β = 0.005, P = .01). Hispanic populations exhibited lower rural mortality, with a stable RR (0.93, P = 1.0). The most common CVD cause was ischemic heart disease (53.93% of rural and 55.9% of urban deaths).
An increasing rural-to-urban disparity in CVD mortality among cancer patients highlights the role of urbanization in health inequities. Interventions targeting rural health care access and socioeconomic disparities are essential to address this growing gap.
心血管疾病死亡是癌症患者死亡的主要原因，城市化等社会人口因素会影响其结局。
研究1999年至2020年美国县级城市化对癌症患者心血管疾病死亡率的影响。
使用美国疾病控制与预防中心（CDC）的WONDER死亡率数据进行回顾性横断面分析。
根据2013年美国国家卫生统计中心（NCHS）的城乡分类方案，将美国各县分为农村或城市。
患有心血管疾病（国际疾病分类第十版：I00 - I78）和合并癌症（国际疾病分类第十版：C00 - C97）的患者，涵盖1999年至2020年美国所有县。
每10万人口的年龄调整死亡率（AAMRs）以及95%置信区间的农村与城市死亡率比值（RRs）。
癌症患者心血管疾病的累积农村与城市RR为1.11（95%CI：1.10 - 1.11），从1999年的1.00增至2020年的1.20（β = 0.009，P <.001）。农村的AAMRs在各人口群体中均较高，包括男性（每10万人口中分别为12.85和11.62）、女性（6.08和5.58）、黑人个体（9.76和9.64）以及白人个体（8.79和7.94）。农村黑人人口的RR从1999年的0.85升至2020年的1.04（β = 0.005，P =.01）。西班牙裔人口的农村死亡率较低，RR稳定（0.93，P = 1.0）。最常见的心血管疾病病因是缺血性心脏病（农村死亡病例中的53.93%和城市死亡病例中的55.9%）。
癌症患者心血管疾病死亡率的城乡差距不断扩大，凸显了城市化在健康不平等中的作用。针对农村医疗保健可及性和社会经济差距的干预措施对于缩小这一日益扩大的差距至关重要。
