Abstract A072: Racial and ethnic disparities in cardiovascular disease mortality among head and neck cancer survivors, 2000-2023

Abstract

Increasing survival for head and neck cancer (HNC) patients raises concerns about risk of cardiovascular disease (CVD), due to shared risk factors (e.g., smoking, heavy alcohol use) and long-term cardiotoxic effects of cancer and its treatments. HNC survivors are more likely develop and die of CVD compared with the general population in the U.S., and CVD risk factors differs by race and ethnicity; however, evaluating the role of race and ethnicity on CVD mortality among HNC patients has not been well characterized. Using the SEER 17 Registries database, we included 181,699 HNC (oral cavity, pharynx, larynx) survivors aged 20-89 years, diagnosed between 2000-2022, survived at least 1 year, and followed until 2023. We estimated ten-year cumulative mortality of CVD by race and ethnicity [Hispanic (N=15,985), non-Hispanic American Indian Alaska Native (AI/AN; N=951), non-Hispanic Asian (N=10,704), non-Hispanic Black (N=16,348), non-Hispanic Pacific Islander (N=1,040), non-Hispanic White (N=136,671)], accounting for competing risks of cancer- and other non-cancer deaths. To compare relative differences, we evaluated hazard ratios (HRs) for CVD mortality by race and ethnicity using Cox proportional hazards models with attained age as the time scale, adjusted for sex, year of diagnosis, chemotherapy, radiotherapy, marital status at diagnosis, county-level income, and rurality. Models were stratified by cancer site and sex. Across 22 years of follow-up, there were 10,813 CVD deaths among White HNC survivors (10-year CM: 7.3%; 95% confidence interval (95%CI): 7.1-7.4), 1,206 CVD deaths among Black HNC survivors (6.9%; 6.4-7.3), 56 CVD deaths among Pacific Islander HNC survivors (5.8%; 4.2-7.7), 51 CVD deaths among AI/AN HNC survivors (5.4%; 3.9-7.2),817 CVD deaths among Hispanic HNC survivors [4.9%; 4.5-5.3], and 460 CVD deaths among Asian HNC survivors (3.8%; 3.4-4.2). Absolute risks of CVD mortality were high for White and Black patients with larynx cancer (White 10-year cumulative mortality=9.6%; 9.3-10; Black 10-year cumulative mortality=8.5%; 7.7-9.3). Relative to non-Hispanic White HNC survivors overall, CVD mortality risk was higher for Black survivors (HR=1.2; 95%CI 1.1-1.3), lower for Asian (HR=0.6; 0.6-0.7) and Hispanic (HR=0.8; 0.7-0.9) survivors, and had no clear difference for Pacific Islander (HR=1.2; 0.9-1.6) and AI/AN survivors (HR=0.9; 0.7-1.3). Increased CVD mortality risk was also observed for Black men and women with oral cavity cancer (male HR=1.3; 1.2-1.5; female HR=1.5; 1.2-1.7) and Black women with pharynx cancer (HR=1.6; 1.1-2.3), but not for larynx cancer. Similar lower CVD mortality patterns were observed for Asian and Hispanic men and women across cancer sites. We observed elevated CVD mortality risk for Black patients diagnosed with oral cavity and pharynx cancer. These findings underscore the importance of managing CVD risk factors that are common among high-risk HNC survivors, paired with long-term survivorship services and CVD screening, to reduce CVD mortality disparities. Jacqueline B. Vo, Isha Patel, Kekoa Taparra, Angelina J. Cho, Stephanie TY. Ho, Yuehan Wang, Michelle O. Sodipo, Meng-Han Tsai, Ronald C. Eldridge, Loretto J. Carvajal, Youjeong Kang, Meredith S. Shiels, Aimee R. Kreimer, Canhua Xiao, Jaimie Z. Shing. Racial and ethnic disparities in cardiovascular disease mortality among head and neck cancer survivors, 2000-2023 [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A072.