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.
背景：心血管疾病（CVD）是结直肠癌（CRC）患者常见的死亡原因。本研究探讨了社区社会经济劣势是否与CRC患者的心血管疾病死亡率相关。 方法：数据来源于美国国家癌症研究所的监测、流行病学和最终结果（SEER）数据库，纳入2006年至2017年间确诊的原发性CRC患者。社区劣势程度采用社会经济综合指标Yost指数的五分位数进行衡量。在控制人口统计学和临床协变量的前提下，使用竞争风险原因别风险模型评估了特定原因死亡率（心血管疾病相关死亡率和结直肠癌相关死亡率）。通过累积发生率函数（CIF）和限制性平均生存时间（RMST）分析，对绝对风险和生存差异进行了补充估计。 结果：本研究共纳入316,549名CRC患者。癌症特异性死亡是主要死因（占62.1%），而心血管疾病死亡占9.6%。多变量竞争风险Cox回归分析显示，与最高社会经济地位社区（第5组）相比，最低社会经济地位社区（第1组）的患者具有更高的心血管疾病特异性死亡率（风险比HR为1.39；95%置信区间CI为1.30–1.48；p < 0.001）。RMST和CIF分析揭示了类似的剂量-反应模式，即随着社区劣势程度的增加，心血管疾病死亡率逐步升高。效应修饰分析表明，这种关联在老年患者和男性中更强，但未发现种族间的修饰作用。 结论：在CRC患者中，居住于社会经济劣势社区与更高的心血管疾病死亡率独立相关，这提示了关注劣势人群心血管风险的重要性。
Neighborhood Disadvantage and Cardiovascular Mortality Among Colorectal Cancer Survivors
肿瘤(癌症)患者之家