Men, Minority Patients in Urban Areas With Early-Onset CRC Face Higher CVD Mortality Risk: Meng-Han Tsai, PhD

A research letter published earlier this month in the Journal of the American Heart Association found that among patients with early-onset colorectal cancer (CRC), defined as CRC diagnosed before age 50, men and racial and ethnic minority patients living in urban areas face a disproportionately elevated risk of cardiovascular disease (CVD) death.

In part 1 of an interview with The American Journal of Managed Care^® (AJMC^®), Meng-Han Tsai, PhD, the study's lead investigator, shared what motivated her to examine cardiovascular mortality in patients with early-onset CRC. She also outlined the study’s objectives and methods and highlighted the findings that stood out most to her.

Watch the interview here.

This transcript has been lightly edited for clarity.

AJMC: What motivated you to examine cardiovascular mortality specifically in patients with early-onset CRC? What makes this intersection so important right now?

There's a term we call “cardio-oncology” because CVD and CRC actually share risk factors. A lot of factors, for example, your lifestyle, eating patterns, or any physical activity, can definitely link together. Some of the patients, maybe for the young population, may have some potential risk of developing CVD even when they are young. So that's why I'm wondering, can those preconditions also impact their cancer outcomes?

That's what triggered me to understand how that impacts the younger population. The other part is that we know that CVD mortality a lot of times comes after their cancer treatment, so there can be so many different factors. It kind of triggered me to want to explore a little bit further on this topic.

AJMC: With that in mind, can you briefly describe the objectives of your study and the methods you used to investigate them?

For this particular project, I looked at the demographic difference and the geographic difference, and then I looked at those diagnosed with CRC aged younger than 50 and how their conditions relate to CVD mortalities.

The reason I'm looking at this is that we know understanding who is affected is always important. For example, which sex group, which race group, and, for the geographic factor, it is always good to know where they live: if they live in a rural area or a more urban area. That way, we can help them to maybe get more access to care, so maybe we can reduce the premature CVD mortality.

For this project, I'm using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. That's a nationally based dataset, so it's more population-level data. I basically used secondary data analysis. I wanted to understand what the patterns are for the younger populations affected by CRC.

AJMC: Overall, did any findings particularly surprise you? If so, which ones stood out most?

Based on my results, it shows more risk for patients who live in fully urban areas. They have a higher risk of CVD deaths. That's kind of a bit surprising to me, because usually we're thinking rural areas are probably impacted more because they lack access to specialty care and have transportation barriers.

But from my results, it’s showing more for the fully urban area. It actually got me thinking about whether it is because the urban setting prioritizes the health care resources for the older population if they have a more complex health condition. But this part definitely needs more data to explore a little bit further. Did the young population not have enough resources to get access to care?