Gender, place of death, and racial disparities in the reporting odds ratio of cardiovascular disease burden in leukemia across age groups (15–85) in the U.S.: A CDC WONDER disproportionality analysis.

Abstract

1535 Background: Leukemia, a hematologic malignancy, often coexists with cardiovascular disease (CVD), worsening outcomes due to shared risk factors like diabetes, hypertension, and smoking. Despite CVD's known impact on leukemia mortality, research on demographic and geographic disparities remains limited. This study examines disparities in the Reporting Odds Ratio (ROR) of CVD burden among leukemia deaths across age, gender, place of death, and race/ethnicity using CDC WONDER data (1999–2020). Methods: A disproportionality analysis of CDC WONDER death certificate data for U.S. adults (15–85) was conducted. Records were grouped into four variables: leukemia deaths with CVD (A), leukemia deaths (B), CVD deaths (C), and all deaths (D). RORs were calculated as (A/B) / (C/D) and stratified by gender, race/ethnicity, urbanization, and place of death. Age groups were categorized into 15–24, 25–64, and 65+ years. Joinpoint regression was used to compute annual percentage change (APC) and average annual percentage change (AAPC) to identify trends. Results: Analysis of 22 years of data revealed disparities in RORs across demographics. The 15–24 age group had the highest ROR for males (2.51) and females (1.59), indicating a greater CVD burden in leukemia deaths than all-cause mortality. Middle-aged (25–64) and older adults (65+) had lower RORs (<1), suggesting a reduced CVD-leukemia burden in these groups. Trends: The young female cohort showed a sharp ROR decline (2018–2020, APC: -22.02%; 95% CI -36.00 to -1.23; p=0.039), while the elderly male cohort (85+) had a steady rise (APC: 6.93%; 95% CI 1.74–9.24; p<0.0001). Place of Death: Medical facilities had the highest CVD burden in leukemia deaths, especially in younger cohorts (15–24; ROR: 1.47). Hospice facilities had the lowest RORs across age groups. The "Other/Unknown" category had an outlier ROR of 4.81 in the youngest cohort, suggesting data limitations. Race/Ethnicity: Hispanics had the highest ROR (2.64) in the 15–24 age group, followed by Asians (2.21). In middle and older age groups, RORs declined for all races. Hispanics (65–74) showed an increasing ROR trend (AAPC: 0.92%; 95% CI 0.45–1.36; p=0.002). Conclusions: Significant disparities exist in CVD burden among leukemia deaths, with younger cohorts, males, Hispanics, and patients in medical facilities showing the highest RORs. These findings highlight the need for targeted cardio-oncology strategies to address CVD risk in leukemia patients. Further research on chemotherapy-related cardiotoxicity and healthcare disparities is crucial to reducing inequities and improving outcomes.