Abstract
Objective
To describe age and sex-specific prevalence of cancer in acute ischemic stroke (AIS)
hospitalizations in the United States over the last decade.
Methods
We conducted a retrospective serial cross-sectional study using all primary AIS discharges
(weighted n=5,748,358) with and without cancer in the 2007-2019 National Inpatient
Sample. Admissions with primary central nervous system cancers were excluded. Joinpoint
regression was used to compute the average annualized percentage change (AAPC) in
cancer prevalence over time.
Results
Across the study period, 12.7% of AIS admissions had previous/active cancer, while
4.4% had active cancer. Of these, 18.8% were hematologic cancers, 47.2% were solid
cancers without metastasis and 34.0% were metastatic cancers of any type. Age-adjusted
active cancer prevalence differed by sex (males:4.8%; females:4.0%) and increased
with age up to age 70-79 years (30-39 years 1.4%; 70-79 years:5.7%). Amongst cancer
admissions, lung (18.7%) and prostate (17.8%) were the most common solid cancers in
men, while lung (19.6%) and breast (13.7%) were the most prevalent in women. Active
cancer prevalence increased over time (AAPC 1.7%, p<0.05) but the pace of increase
was significantly faster in women (AAPC 2.8%) compared to men (AAPC 1.1%) (p-comparison
=0.003). Fastest pace of increased prevalence was seen for genitourinary cancers in
women and for gastrointestinal cancers in both sexes. Genitourinary cancers in men
declined over time (AAPC -2.5%, p<0.05). Lung cancer prevalence increased in women
(AAPC 1.8%, p<0.05) but remained constant in men. Prevalence of head/neck, skin/bone,
gastrointestinal, hematological and metastatic cancers increased over time at similar
pace in both sexes.
Conclusion
Prevalence of cancer in AIS admissions increased in the US over the last decade but
the pace of this increase was faster in women compared to men. Gastrointestinal cancers
in both sexes and genitourinary cancers in women are increasing at the fastest pace.
Additional studies are needed to determine whether this increase is from co-occurrence
or causation of AIS by cancer.
Keywords
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Article info
Publication history
Published online: October 29, 2022
Accepted:
October 2,
2022
Received in revised form:
September 29,
2022
Received:
July 21,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106818
Copyright
© 2022 Elsevier Inc. All rights reserved.