Differences in Long Term Cancer Incidence and Overall Mortality Rate between Cardiovascular Diseases: A Nationwide Retrospective Health Insurance Claims Analysis.

Abstract

Both cardiovascular disease (CVD) and cancer significantly contribute to global mortality and morbidity, with increasing recognition of their potential interrelationship. This study determined cancer incidence and overall survival rates among six CVD subtypes to inform integrated care pathways. Longitudinally linked research data were obtained from BARMER, the second largest health insurance fund in Germany. The incidence of cancer and death was determined over a five year period following index hospitalisation for CVD across matched cohorts, comprising patients with either lower extremity peripheral arterial disease (PAD), aortic aneurysm or dissection, carotid stenosis, coronary heart disease, atrial fibrillation, or heart failure. Propensity score matching was used to adjust for age, sex, and Elixhauser comorbidities. Patients with a previous cancer diagnosis or those who died within 30 days after discharge were excluded. Among the 46 798 propensity score matched patients with CVD, the five year incidence of cancer ranged from 10.2% in heart failure to 17.3% in carotid stenosis, while higher incidences were observed in men. Overall mortality rates after five years varied widely, with the highest rate observed in men with PAD (29.2%, 95% confidence interval [CI] 28.0 - 30.4%) and women with PAD (26.2%, 95% CI 24.4 - 28.1%), highlighting the particularly high mortality burden in PAD compared with other CVD subgroups. The findings of the current study illustrate a significant variation in both cancer incidence and subsequent survival rates among CVD subtypes, with PAD being associated with worse survival.