Neighborhood Disadvantage and Cardiovascular Mortality Among Colorectal Cancer Survivors

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Background: Cardiovascular disease (CVD) is a common cause of death among colorectal cancer (CRC) patients. We examined whether neighborhood disadvantage is associated with CVD mortality in CRC patients. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program for primary CRC patients diagnosed between 2006 and 2017. Neighborhood disadvantage was measured using the quintiles of the Yost Index, a socioeconomic composite measure. Cause-specific mortality (CVD-specific and CRC-specific mortality) was evaluated using a competing risk cause-specific hazard model, controlling for demographic and clinical covariates. Cumulative incidence function (CIF) and restricted mean survival time (RMST) analyses were performed to provide complementary estimates of absolute risk and survival differences. Results: The study included 316,549 patients with CRC. Cancer-specific mortality was the leading cause of death (62.1%), while CVD accounted for 9.6% of deaths. Multivariable competing risk Cox regression showed that the lowest-SES neighborhoods (Group 1) had a higher CVD-specific mortality (HR, 1.39; 95% CI, 1.30–1.48; p < 0.001) compared to the highest-SES neighborhoods (Group 5). RMST and CIF analyses revealed a similar dose–response pattern, with progressively higher CVD mortality associated with increasing levels of neighborhood disadvantage. Effect modification analyses indicated stronger associations in older patients and men, but no modifications by race. Conclusions: Among CRC patients, residing in disadvantaged neighborhoods was independently associated with higher CVD mortality, suggesting the importance of addressing cardiovascular risk in disadvantaged populations.

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