Chronic comorbid conditions among adult cancer survivors in the United States: Results from the National Health Interview Survey, 2002-2018

Abstract

Background: Cancer survivors develop other chronic medical conditions because of shared risk factors and delayed effects of cancer treatment. This study investigated trends in the prevalence of chronic diseases and estimated their population sizes among adult cancer survivors in the United States from 2002 to 2018.

Methods: Using 2002-2018 National Health Interview Survey data, this study calculated the age-sex-race/ethnicity-adjusted prevalences and estimated the population sizes for the following chronic conditions among cancer survivors: hypertension, diabetes, stroke, heart disease, chronic obstructive pulmonary disease (COPD)/asthma, hepatitis, arthritis, liver disease, kidney disease, and morbid obesity. This study also examined multiple chronic conditions (MCC; 3 or more health conditions). MCC trends were further examined by sociodemographic factors to identify high-risk populations. Parallel analyses were performed for participants without a cancer history to provide a reference.

Results: Among 30,728 cancers survivors, increasing trends were observed in the prevalence of hypertension, diabetes, kidney disease, liver disease, and morbid obesity, whereas decreasing prevalence trends were observed for ischemic heart disease, COPD, and hepatitis. Cancer survivors with MCC increased from 4.7 million in 2002 to 8.1 million in 2018 (the prevalence increased from 43.7% to 46.6%). The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the MCC prevalence also increased, although more slowly than among survivors.

Conclusions: The number of adult cancer survivors in the United States with comorbid illnesses has increased substantially over the past 2 decades. Optimal management of comorbid conditions and aggressive interventions for risk reduction may benefit the cancer survivor population.

Keywords: cancer survivorship; comorbidity; disease burden; multimorbidity management; public health.

Figure 1.

Flowchart of the study population inclusion/exclusion and analyses.

Figure 2.

Age-sex-race/ethnicity-adjusted prevalence of chronic conditions among cancer survivors and individuals without a cancer history in the US ^{a a} Data estimates were aggregated at 6 study periods COPD stands for chronic obstructive pulmonary disease

Figure 2.

Age-sex-race/ethnicity-adjusted prevalence of chronic conditions among cancer survivors and individuals without a cancer history in the US ^{a a} Data estimates were aggregated at 6 study periods COPD stands for chronic obstructive pulmonary disease

Figure 2.

Age-sex-race/ethnicity-adjusted prevalence of chronic conditions among cancer survivors and individuals without a cancer history in the US ^{a a} Data estimates were aggregated at 6 study periods COPD stands for chronic obstructive pulmonary disease

Figure 3.

Estimated Population Sizes of Cancer Survivors with Chronic Conditions in the US ^{a a} The absolute population with chronic conditions was estimated using National Health Interview Survey complex survey design and weights. COPD stands for chronic obstructive pulmonary disease

Figure 4.

Age-sex-race/ethnicity-adjusted prevalence of multiple chronic conditions (3 or more) by age group among cancer survivors and individuals without a cancer history in the US ^{a a} Data estimates were aggregated at 6 study periods

Figure 5.

Estimated Population Sizes of Cancer Survivors with Multiple Chronic Conditions (3 or more) by Demographic and Clinical Factors in the US^{a a} The weighted population with multiple chronic conditions was estimated based on National Health Interview Survey complex survey design and weights.

Figure 5.

Estimated Population Sizes of Cancer Survivors with Multiple Chronic Conditions (3 or more) by Demographic and Clinical Factors in the US^{a a} The weighted population with multiple chronic conditions was estimated based on National Health Interview Survey complex survey design and weights.

Figure 5.

Estimated Population Sizes of Cancer Survivors with Multiple Chronic Conditions (3 or more) by Demographic and Clinical Factors in the US^{a a} The weighted population with multiple chronic conditions was estimated based on National Health Interview Survey complex survey design and weights.

Figure 5.

Estimated Population Sizes of Cancer Survivors with Multiple Chronic Conditions (3 or more) by Demographic and Clinical Factors in the US^{a a} The weighted population with multiple chronic conditions was estimated based on National Health Interview Survey complex survey design and weights.