Racial Disparities in Cardiovascular and Cerebrovascular Adverse Events in Patients with Non-Hodgkin Lymphoma: A Nationwide Analysis

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Specialty General Medicine

Date 2024 May 25

PMID 38792983

Authors

Kanishka Uttam Chandani

Siddharth Pravin Agrawal

Maharshi Raval

Sajid Siddiq

Ahmed Nadeem

Ashish V Chintakuntlawar

Shahrukh K Hashmi

Affiliations

Soon will be listed here.

Abstract

: Non-Hodgkin lymphoma (NHL) has the sixth-highest malignancy-related mortality in the United States (US). However, inequalities exist in access to advanced care in specific patient populations. We aim to study the racial disparities in major adverse cardiovascular and cerebrovascular events (MACCEs) in NHL patients. : Using ICD-10 codes, patients with NHL were identified from the US National Inpatient Sample 2016-2019 database. Baseline characteristics, comorbidities, and MACCE outcomes were studied, and results were stratified based on the patient's race. : Of the 777,740 patients with a diagnosis of NHL, 74.22% (577,215) were White, 9.15% (71,180) were Black, 9.39% (73,000) were Hispanic, 3.33% (25,935) were Asian/Pacific Islander, 0.36% (2855) were Native American, and 3.54% (27,555) belonged to other races. When compared to White patients, all-cause mortality (ACM) was significantly higher in Black patients (aOR 1.27, 95% CI 1.17-1.38, < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12-1.45, < 0.001). Sudden cardiac death was found to have a higher aOR in all racial sub-groups as compared to White patients; however, it was statistically significant in Black patients only (aOR 1.81, 95% CI 1.52-2.16, < 0.001). Atrial fibrillation (AF) risk was significantly lower in patients who were Black, Hispanic, and of other races compared to White patients. Acute myocardial infarction (AMI) was noted to have a statistically significantly lower aOR in Black patients (0.70, 95% CI 0.60-0.81, < 0.001), Hispanic patients (0.69, 95% CI 0.59-0.80, < 0.001), and patients of other races (0.57, 95% CI 0.43-0.75, < 0.001) as compared to White patients. : Racial disparities are found in MACCEs among NHL patients, which is likely multifactorial, highlighting the need for healthcare strategies stratified by race to mitigate the increased risk of MACCEs. Further research involving possible epigenomic influences and social determinants of health contributing to poorer outcomes in Black and Asian/Pacific Islander patients with NHL is imperative.

References

Meijers W, Maglione M, Bakker S, Oberhuber R, Kieneker L, de Jong S . Heart Failure Stimulates Tumor Growth by Circulating Factors. Circulation. 2018; 138(7):678-691. DOI: 10.1161/CIRCULATIONAHA.117.030816. View

Sturgeon K, Deng L, Bluethmann S, Zhou S, Trifiletti D, Jiang C . A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J. 2019; 40(48):3889-3897. PMC: 6925383. DOI: 10.1093/eurheartj/ehz766. View

Crozier J, Sher T, Yang D, Swaika A, Foran J, Ghosh R . Persistent Disparities Among Patients With T-Cell Non-Hodgkin Lymphomas and B-Cell Diffuse Large Cell Lymphomas Over 40 Years: A SEER Database Review. Clin Lymphoma Myeloma Leuk. 2015; 15(10):578-85. PMC: 7546202. DOI: 10.1016/j.clml.2015.06.005. View

Avraham S, Abu-Sharki S, Shofti R, Haas T, Korin B, Kalfon R . Early Cardiac Remodeling Promotes Tumor Growth and Metastasis. Circulation. 2020; 142(7):670-683. DOI: 10.1161/CIRCULATIONAHA.120.046471. View

Kommalapati A, Tella S, Ganti A, Armitage J . Natural Killer/T-cell Neoplasms: Analysis of Incidence, Patient Characteristics, and Survival Outcomes in the United States. Clin Lymphoma Myeloma Leuk. 2018; 18(7):475-479. DOI: 10.1016/j.clml.2018.04.009. View

Christidi E, Brunham L . Regulated cell death pathways in doxorubicin-induced cardiotoxicity. Cell Death Dis. 2021; 12(4):339. PMC: 8017015. DOI: 10.1038/s41419-021-03614-x. View

Guadamuz J, Ozenberger K, Qato D, Ko N, Saffore C, Adimadhyam S . Mediation analyses of socioeconomic factors determining racial differences in the treatment of diffuse large B-cell lymphoma in a cohort of older adults. Medicine (Baltimore). 2019; 98(46):e17960. PMC: 6867777. DOI: 10.1097/MD.0000000000017960. View

Zhang L, Rothman N, Li G, Guo W, Yang W, Hubbard A . Aberrations in chromosomes associated with lymphoma and therapy-related leukemia in benzene-exposed workers. Environ Mol Mutagen. 2007; 48(6):467-74. DOI: 10.1002/em.20306. View

Jia G, Aroor A, Jia C, Sowers J . Endothelial cell senescence in aging-related vascular dysfunction. Biochim Biophys Acta Mol Basis Dis. 2019; 1865(7):1802-1809. DOI: 10.1016/j.bbadis.2018.08.008. View

10.

Bellinger A, Arteaga C, Force T, Humphreys B, Demetri G, Druker B . Cardio-Oncology: How New Targeted Cancer Therapies and Precision Medicine Can Inform Cardiovascular Discovery. Circulation. 2015; 132(23):2248-58. PMC: 4863699. DOI: 10.1161/CIRCULATIONAHA.115.010484. View

11.

Kirtane K, Lee S . Racial and ethnic disparities in hematologic malignancies. Blood. 2017; 130(15):1699-1705. PMC: 5639484. DOI: 10.1182/blood-2017-04-778225. View

12.

Emole J, Lawal O, Lupak O, Dias A, Shune L, Yusuf K . Demographic differences among patients treated with chimeric antigen receptor T-cell therapy in the United States. Cancer Med. 2022; 11(23):4440-4448. PMC: 9741965. DOI: 10.1002/cam4.4797. View

13.

Thandra K, Barsouk A, Saginala K, Padala S, Barsouk A, Rawla P . Epidemiology of Non-Hodgkin's Lymphoma. Med Sci (Basel). 2021; 9(1). PMC: 7930980. DOI: 10.3390/medsci9010005. View

14.

Burns E, Gentille C, Trachtenberg B, Pingali S, Anand K . Cardiotoxicity Associated with Anti-CD19 Chimeric Antigen Receptor T-Cell (CAR-T) Therapy: Recognition, Risk Factors, and Management. Diseases. 2021; 9(1). PMC: 8006027. DOI: 10.3390/diseases9010020. View

15.

Hall A, Winestone L, Sullivan E, Wu Q, Lamble A, Walters M . Access to Chimeric Antigen Receptor T Cell Clinical Trials in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult Acute Lymphobastic Leukemia Patients. Transplant Cell Ther. 2023; 29(6):356.e1-356.e7. PMC: 10247402. DOI: 10.1016/j.jtct.2023.03.022. View

16.

Ailawadhi S, Aldoss I, Yang D, Razavi P, Cozen W, Sher T . Outcome disparities in multiple myeloma: a SEER-based comparative analysis of ethnic subgroups. Br J Haematol. 2012; 158(1):91-8. DOI: 10.1111/j.1365-2141.2012.09124.x. View

17.

de Leval L, Jaffe E . Lymphoma Classification. Cancer J. 2020; 26(3):176-185. DOI: 10.1097/PPO.0000000000000451. View

18.

Mestas J, Hughes C . Of mice and not men: differences between mouse and human immunology. J Immunol. 2004; 172(5):2731-8. DOI: 10.4049/jimmunol.172.5.2731. View

19.

Gonuguntla K, Sattar Y, Iqbal K, Sharma A, Yadav R, Alharbi A . Trends in Premature Mortality from Acute Myocardial Infarction in American Indians/Alaska Natives in the United States from 1999 to 2020. Am J Cardiol. 2023; 213:72-75. DOI: 10.1016/j.amjcard.2023.12.019. View

20.

Karlstaedt A, Moslehi J, de Boer R . Cardio-onco-metabolism: metabolic remodelling in cardiovascular disease and cancer. Nat Rev Cardiol. 2022; 19(6):414-425. PMC: 10112835. DOI: 10.1038/s41569-022-00698-6. View