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[Preprint]. 2024 Apr 1:rs.3.rs-4139837.
doi: 10.21203/rs.3.rs-4139837/v1.

Rurality, Cardiovascular Risk Factors, and Early Cardiovascular Disease among Childhood, Adolescent, and Young Adult Cancer Survivors

David H Noyd  1 , Anna Bailey  2 , Amanda Janitz  2 , Talayeh Razzaghi  3 , Sharon Bouvette  4 , William Beasley  4 , Ashley Baker  4 , Sixia Chen  2 , David Bard  4
Affiliations

Rurality, Cardiovascular Risk Factors, and Early Cardiovascular Disease among Childhood, Adolescent, and Young Adult Cancer Survivors

David H Noyd et al. Res Sq. .

Update in

Abstract

Background and aims: Cardiovascular risk factors (CVRFs) later in life potentiate risk for late cardiovascular disease (CVD) from cardiotoxic treatment among survivors. This study evaluated the association of baseline CVRFs and CVD in the early survivorship period.

Methods: This analysis included patients ages 0-29 at initial diagnosis and reported in the institutional cancer registry between 2010 and 2017 (n = 1228). Patients who died within five years (n = 168), those not seen in the oncology clinic (n = 312), and those with CVD within one year of diagnosis (n = 17) were excluded. CVRFs (hypertension, diabetes, dyslipidemia, and obesity) within one year of initial diagnosis, were constructed and extracted from the electronic health record based on discrete observations, ICD9/10 codes, and RxNorm codes for antihypertensives.

Results: Among survivors (n = 731), 10 incident cases (1.4%) of CVD were observed between one year and five years after the initial diagnosis. Public health insurance (p = 0.04) and late effects risk strata (p = 0.01) were positively associated with CVD. Among survivors with public insurance(n = 495), two additional cases of CVD were identified from claims data with an incidence of 2.4%. Survivors from rural areas had a 4.1 times greater risk of CVD compared with survivors from urban areas (95% CI: 1.1-15.3), despite adjustment for late effects risk strata.

Conclusions: Clinically computable phenotypes for CVRFs among survivors through informatics methods were feasible. Although CVRFs were not associated with CVD in the early survivorship period, survivors from rural areas were more likely to develop CVD.

Implications for survivors: Survivors from non-urban areas and those with public insurance may be particularly vulnerable to CVD.

Keywords: Cardio-Oncology; Clinical Research Informatics; Late Effects from Childhood Cancer; Survivorship.

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Conflict of interest statement

Conflicts of Interest: The authors declare no competing interests.

Figures

Figure 1
Figure 1
Childhood, Adolescent, and Young Adult Cancer Survivorship Cohort Construction
Figure 2
Figure 2
Temporal relationship between cardiovascular risk factors (CVRFs) at baseline or during treatment and the development of cardiovascular disease (CVD) in the early survivorship period
See this image and copyright information in PMC

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