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

## TL;DR

This study finds racial disparities in cardiovascular and cerebrovascular risks among non-Hodgkin lymphoma patients in the US.

## Contribution

The study identifies specific racial differences in adverse cardiovascular events among NHL patients using a nationwide database.

## Key findings

- Black and Asian/Pacific Islander NHL patients had higher all-cause mortality compared to White patients.
- Black patients had significantly higher risk of sudden cardiac death compared to White patients.
- Black, Hispanic, and other race patients had lower risk of atrial fibrillation and acute myocardial infarction compared to White patients.

## Abstract

Background and Objectives: 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. Materials and Methods: 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. Results: 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, p < 0.001) and in Asian/Pacific Islander patients (aOR 1.27, 95% CI 1.12–1.45, p < 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, p < 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, p < 0.001), Hispanic patients (0.69, 95% CI 0.59–0.80, p < 0.001), and patients of other races (0.57, 95% CI 0.43–0.75, p < 0.001) as compared to White patients. Conclusions: 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.