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

## TL;DR

This study finds that cancer survivors from rural areas are more likely to develop early cardiovascular disease compared to those in urban areas.

## Contribution

The study introduces a method to assess cardiovascular risk factors in cancer survivors using electronic health records and identifies rural residency as a novel risk factor.

## Key findings

- Survivors from rural areas had 4.1 times greater risk of CVD compared to urban survivors.
- Public health insurance was positively associated with CVD in survivors.
- CVRFs were not directly linked to CVD in the early survivorship period.

## Abstract

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.

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.

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.

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.

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