Trends of stroke-related mortality among patients with cancer in the United States, 1999-2020.

Abstract

e24021 Background: Patients with cancer are at an increased risk of stroke and stroke-related mortality via various mechanisms such as hypercoagulability, direct tumor effects, and largely as side effects of treatments. Enhancement of thrombin release from chemotherapy induced release of extracellular vesicles and cell-free DNA, and the use of angiogenesis inhibitors are some of the proposed mechanisms for stroke development in patients with cancer. Despite this, current guidelines lack clarity in identifying patients with cancer as having moderate to high risk of mortality from stroke. Recognizing this complex relationship is pivotal for crafting comprehensive care plans that address the dual challenges of cancer and stroke risks. Hence, our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from “1999 to 2020”. Methods: We analyzed national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual percent change (APC) was calculated using the Joinpoint regression software. Results: A total of 36,648 stroke-related deaths among patients with cancer occurred between 1999 and 2020. The APC trends are as follows: a major decrease of -6.8 (95% CI: -11.8 to -1.5) from 2002 to 2009, a slight decline of -1.23 (95% CI: -13.8 to 13.2) from 2009 to 2014, a significant decrease of -6.71 (95% CI: -46.2 to 61.7) from 2014 to 2017, and an increase of 2.07 (95% CI: -26.1 to 41.1) from 2017 to 2020. Men consistently showed higher mortality rates compared to women in 1999 (AAMR Men: 1.0 vs Women: 0.63) and 2020 (AAMR Men: 0.94 vs Women: 0.69). Moreover, when stratified by race non-hispanic (NH) Black showed the highest mortality rate, followed by NH Whites, and Hispanics throughout the study period between 1999 (AAMR NH Black: 0.96 vs NH White: 0.75 vs Hispanic: 0.32) and 2020 (AAMR NH Black: 0.85 vs NH White: 0.81 vs Hispanic: 0.53). Rural areas compared to urban areas showed consistently higher mortality rates over the study period. Conclusions: Despite more than a decade-long decline, stroke-related mortality among cancer patients has significantly increased since 2015. Targeted therapy and investigations into the role of social determinants of health may improve care for these patients. Further investigation is warranted to elucidate the mechanisms for the increase in stroke-related mortality among people with cancer, particularly those with the following demographics: Men, Black or African American, and residents of rural areas and Midwestern regions.