PO.PS01.05 · 人群科学
西班牙裔社区健康研究/拉丁裔研究中成年癌症幸存者的心-肾-代谢健康
Cardio-kidney metabolic health among adult cancer survivors in the Hispanic Community Health Study/Study of Latinos
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：与一般人群相比，癌症幸存者发生心血管、肾脏和代谢（CKM）疾病的风险更高。然而，有癌症史的西班牙裔/拉丁裔成人中CKM疾病的患病率和进展情况仍未得到充分探讨。利用基于社区的西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL）的数据，我们考察了平均六年间CKM疾病的变化及CKM疾病进展的预测因素，并按基线癌症史进行分层。
方法：我们纳入了2008-2011年访视1时来自HCHS/SOL的16,415名参与者，其中有癌症史者（n=644）和无癌症史者（n=15,771）。访视1和2014-2017年访视2时的CKM分期根据2023年美国心脏协会（AHA）CKM分期框架定义。2023年AHA建议定义了五个CKM分期（0-4），从无CKM危险因素（0期）依次进展至脂肪过多或功能失调（1期）、代谢综合征或慢性肾病（2期）、亚临床心血管疾病或风险等同（3期），以及确诊的心血管疾病（4期）。采用描述性统计评估两次访视之间CKM分期的患病率和转变。采用调查加权多变量logistic模型和Fine-Gray竞争风险模型评估癌症史和社会人口学因素与CKM分期进展之间的关联（比值比OR和95%置信区间CI）。
结果：与无癌症史者相比，有癌症史者年龄更大（平均年龄±标准误=55.8±1.0岁 vs. 47.4±0.2岁）、更可能为女性（65.4% vs. 52.7%）、已退休（29.0% vs. 10.6%）、年度家庭收入<20,000美元（54.9% vs. 47.5%）以及缺乏体力活动（45.0% vs. 36.4%）。癌症幸存者在访视1（24.2% vs. 10.0%）和访视2（35.3% vs. 16.9%）时晚期CKM分期（≥3期）的患病率均更高。尽管两组间CKM恶化的比例相似，但癌症幸存者在随访期间的死亡率显著更高（12.2% vs. 4.8%）。校正社会人口学因素后，癌症史本身并非CKM恶化的预测因素（OR=1.03；95% CI=0.75-1.43）。在考虑竞争性死亡后，癌症幸存者发生CKM分期进展的可能性比无癌症史者低37%（HR=0.63；95% CI=0.47-0.83；P<0.01）。
结论：CKM疾病在西班牙裔成人中普遍存在，随时间推移，癌症幸存者相比无癌症史者经历更晚期的CKM分期和更高的死亡率。
查看英文原文 English abstract
Background: Compared to the general population, cancer survivors are at higher risk for cardiovascular, kidney, and metabolic (CKM) diseases. However, the prevalence and progression of CKM diseases among Hispanic/Latino adults with a history of cancer remain underexplored. Using data from the community-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we examined the changes in CKM diseases and predictors of CKM disease progression over an average of six years, stratified by baseline cancer history.
Methods: We included 16,415 participants from the HCHS/SOL with a history of cancer (n=644) and without a history of cancer (n=15,771) at Visit 1 in 2008-2011. CKM stage at Visit 1 and Visit 2 in 2014-2017 was defined according to the 2023 American Heart Association(AHA)'s CKM stage framework. The 2023 AHA advisory defines five CKM stages (0-4), progressing from no CKM risk factor (stage 0) to excess or dysfunctional adiposity (stage 1), metabolic syndrome or chronic kidney disease (stage 2), subclinical cardiovascular disease or risk equivalent (stage 3), and established cardiovascular disease (stage 4). Descriptive statistics were used to assess the prevalence and transition of CKM stage between visits. Survey-weighted multivariable logistic models and Fine-Gray competing risk models were used to evaluate the associations (odds ratios, ORs, and 95% confidence intervals, CIs) between cancer history and sociodemographic factors and CKM stage progression.
Results: Compared to those without a history of cancer, those with a history of cancer were older (mean age±standard error = 55.8±1.0 versus 47.4±0.2 years), more likely to be female (65.4% versus 52.7%), retired (29.0% versus 10.6%), have an annual household income <$20,000 (54.9% versus 47.5%), and be physically inactive (45.0% versus 36.4%). Cancer survivors had a higher prevalence of advanced CKM stages (≥ stage 3) at both Visit 1 (24.2% versus 10.0%) and Visit 2 (35.3% versus 16.9%). While the proportions of CKM worsening were similar between groups, cancer survivors had a significantly higher mortality rate (12.2% vs 4.8%) during follow-up. Cancer history itself was not a predictor of CKM worsening after adjusting for sociodemographic factors (OR = 1.03; 95% CI = 0.75-1.43). After accounting for competing mortality, cancer survivors were 37% less likely to experience CKM stage progression than those without a cancer history (HR = 0.63; 95%CI = 0.47-0.83; P <0.01).
Conclusion: CKM diseases are prevalent among Hispanic adults, with cancer survivors experiencing more advanced CKM stages and higher mortality rates over time than those without a history of cancer.
利益披露 Disclosure
M. Lee, None..
M. Allison, None..
L. C. Gallo, None..
C. Rosas, None..
D. Sotres-Alvarez, None..
F. J. Penedo, None..
M. Daviglus, None..
J. Lash, None.