Temporal trends and disparities in cardiovascular mortality among breast cancer patients: A 25-year population analysis of the CDC WONDER database (1999-2023).

Abstract

12026 Background: Breast cancer and cardiovascular disease (CVD) are leading causes of mortality among women in the United States. While advancements in breast cancer treatment have improved survival rates, these therapies may contribute to CVD-related complications, influencing long-term outcomes. This study examines 25-year trends (1999–2023) in CVD mortality among breast cancer patients, with a focus on racial, regional, and urbanization disparities. Methods: Data was analyzed from the CDC WONDER (Centers for Disease Control and Prevention for Wide-ranging Online Data for Epidemiologic Research) covering the period from January 1, 1999, to December 31, 2023, to evaluate CVD mortality among breast cancer patients. Analysis was done using Joinpoint regression. Age-adjusted mortality rates (AAMR) per 100,000 person-years were calculated, and trends were assessed using annual percent change (APC) with statistical significance defined at p < 0.05. Disparities were evaluated across racial/ethnic groups, U.S. census regions, and urban-rural settings. Results: 85,316 CVD-related deaths were recorded among breast cancer patients from 1999 to 2023. AAMR declined significantly overall (APC: -2.73, p < 0.001), decreasing from 1.66 in 1999 to a nadir of 0.72 in 2016 (APC: -5.11, p < 0.001), followed by a rebound to 0.84 in 2023 (APC: +3.29, p < 0.001). Disparities were noted among racial groups: non-Hispanic Black women had the highest mortality rates, followed by non-Hispanic Whites and Hispanics, all showing significant downward trends with APCs of -1.93, -2.63, and -2.431, respectively (p < 0.001). The lowest mortality rates were recorded in 2016 for all groups, except for non-Hispanic Blacks, who had their lowest in 2015. Regionally, the Northeast initially had the highest AAMR until 2016, after which rates converged; by 2023, the South reported the highest mortality (0.86). Rural areas consistently exhibited higher AAMR than urban areas, though both declined significantly over the study period. Conclusions: Despite an overall decline in CVD mortality among breast cancer patients, persistent racial, regional, and urban-rural disparities highlight systemic inequities in care. The post-2016 resurgence in mortality underscores potential gaps in long-term cardiovascular surveillance for survivors. Targeted interventions addressing racial disparities, regional resource allocation, and rural healthcare access are critical to mitigating CVD risk in this population. Further research is needed to elucidate drivers of these trends and inform equitable policy reforms.