Age, Race, Insurance Status Can Predict CV Mortality for Those With MPNs

Among those diagnosed with myeloproliferative neoplasms (MPNs), age, race, marital status, and insurance status can help predict cardiovascular mortality (CVM), based on an analysis of more than 24,000 US patient records.¹

A new study finds that clinical factors and social determinants of health can predict cardiovascular mortality among patients with myeloproliferative neoplasms. | Image Credit: yodiyim - stock.adobe.com

The study, appearing this week in Therapeutic Advances in Hematology,¹ aimed to identify prognostic factors that can guide clinicians in treating patients with MPNs, which are a group of hematopoietic stem cell disorders that are generally diagnosed in individuals after age 40; according to the Leukemia & Lymphoma Society, most patients are diagnosed in their 60s or 70s.

The team from Sun Yat-sen University in China culled records for more than 48,000 patients diagnosed with MPNs between 2000 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database, but narrowed their analysis to those records for patients that lived at least a year and included other essential clinical information. That left a database of 24,277 patient records.

Among the demographic findings:

• The database included 10,409 patients (42.9%) with polycythemia vera (PV), 3229 (13.3%) with myelofibrosis (MF) and 10,639 (43.8%) with essential thrombocythemia (ET).
• Prevalence of the condition was higher among White males in PV and MF compared with females in ET.
• At diagnosis, only 8.0% were younger than 40 years old; 29.0% were 40-59 years old, 47.0% were 60-79 years old; and 16% were older than 80 years of age.

The analysis took a snapshot of patients at 200 months of follow-up (16 years, 8 months) and found that the cumulative mortality was the following CVD (17.9%), other noncancer (22.1%), MPN (18.8%), and other cancers (6.1%). However, investigators found that more than 50% of patients initially diagnosed with MF died from their primary disease during this period, which may be due to conversion of their disease to acute myeloid leukemia.

Deaths. Of these individuals, 8841 died during the follow-up period, with 2664 (30.1%) dying from their MPN condition and 2429 dying from CVD (27.5%). In addition, 777 (8.8%) died from other cancers, and 2971 (33.6%) died from diseases besides cancer.

CVD. The primary type of CVD was heart disease (74.2%), followed by cerebrovascular diseases (17.7%), hypertension (4.1%), atherosclerosis (0.7%), aortic aneurysm and dissection (0.9%), and diseases of arteries and capillaries (2.1%).

Other factors. When investigators categorized patients based on age, gender, race, marital status, and insurance status, “Our analysis revealed that the risk associated with all these factors increased over time.”

The authors found that being male, American Indian/Alaska Native, or Asian/Pacific Islander, married, insured, and young meant individuals would have a comparatively lower risk of CVM. For those 80 years or older, CVD increased as a risk factor; for PV patients, it became the main cause of death and played an important role in the cause of death for those with ET or MF.

The data showed 14,064 individuals (57.9%) were married and 10,213 (42.1%) were unmarried. Across the database 6847 patients (28.2%) were insured and 17,430 (71.8%) were listed as not insured; notably, the analysis included years up to 2014, when the Affordable Care Act (ACA) took effect, and insurers could no longer deny patients coverage for preexisting conditions.

“We observed that race, marital status, and insurance status were significant independent predictors of risk factors for CVM. Specifically, the Black population, and individuals without insurance exhibited higher [hazard ratio] and [standardized mortality ratio].”

These results, the authors noted, were consistent with other studies that show Black patients have poorer prognosis with CVM that may start with “the elevated incidence of CVD” in the population, along with socioeconomic factors that make it difficult for these patients to access cardiac rehabilitation.

Being married and having insurance, meanwhile, may offer patients “enhanced emotional and financial support, thereby facilitating early diagnosis, effective treatment, and improved prognosis.”

“The incidence of cardiovascular events is significantly higher in MPN patients compared to the general population,” the authors concluded. “Ttherefore, early screening and assessment of cardiac health should be implemented to prevent such events and improve prognosis.”

Reference

Tang M, Chen Y, Zhou Y. Long-term risks of cardiovascular-specific mortality among myeloproliferative neoplasms patients. Ther Adv Hematol. 2024;15:1–17. DOI: 10.1177/

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