Assessment of poor cardiovascular health metrics and related disparities among cancer patients in the United States: a nationwide analysis of over 1.5 million individuals

Abstract

Abstract Background Cancer, a major health challenge and a leading cause of mortality in the United States, significantly impacts cardiovascular health (CVH). The American Heart Association (AHA) emphasizes several CVH metrics to improve health outcomes, yet disparities in CVH persist nationwide. The specific impact of these disparities on the CVH of individuals with cancer, however, has yet to be fully explored. Purpose This study aims to utilize a detailed and nationally representative dataset from the U.S. to assess the prevalence of poor CVH among adults with a cancer diagnosis, focusing on uncovering sociodemographic disparities. Methods We utilized self-reported data from the Behavioral Risk Factor Surveillance System (2011 to 2019). This system, a state-based telephone survey, gathering data on cancer diagnoses, CVH metrics, and sociodemographic characteristics. We measured CVH through a composite score (0-7) based on the AHA’s seven CVH indicators: hypertension, high cholesterol, smoking, body mass index, diabetes, physical activity, and fruits and vegetables consumption. Individuals scoring between 0 and 2 were defined as having poor CVH. Multivariable generalized linear models within a binomial framework was applied to estimate adjusted prevalence ratios (aPRs) for poor CVH among cancer patients. Results Of 1,575,187 U.S. adults (representing an estimated 154.5 million; 50.7% female, 10.9% non-Hispanic black), 7.8% reported a cancer diagnosis between 2011 and 2019. Adjusted* findings show that having cancer (vs without) associated with a 16% higher prevalence of poor CVH (aPR=1.16; 95% CI [1.12-1.19]). Age-specific analysis revealed increased prevalence of poor CVH in middle-aged (45-64; aPR=3.55) and elderly (≥65; aPR=3.58) cancer patients, indicating a 255% and 358% rise, respectively, with p_interaction <0.001. Female cancer patients experienced a 22% lower prevalence of poor CVH than males (aPR=0.78; p_interaction <0.001). Non-Hispanic black cancer patients faced a 42% higher prevalence of poor CVH than their non-Hispanic white counterparts (aPR=1.42; p_interaction=0.001). Higher-income and education levels associated with 52% and 53% reduced prevalence of poor CVH, respectively (p_interaction <0.001; Table). Conclusions Our research identifies a strong correlation between cancer and deteriorating CVH metrics across U.S. adults, with pronounced variations based on sociodemographic factors. Specifically, the prevalence of poor CVH is substantially higher among cancer patients who are middle-aged, elderly, or identify as non-Hispanic Black, compared to other groups. Conversely, female cancer patients and those with a higher socioeconomic status appear to have a reduced risk of poor CVH. These outcomes stress the critical need for targeted, equitable public health initiatives that address both the cardiovascular and broader health needs of cancer patients, particularly among those most vulnerable.Table1