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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References
- The leading causes of death in the US for 2020.JAMA. 2021; 325: 1829-1830
- Ischemic stroke in cancer patients: a review of an underappreciated pathology.Ann Neurol. 2018; 83: 873-883
- Cancer-related stroke: an emerging subtype of ischemic stroke with unique pathomechanisms.J Stroke. 2020; 22: 1
- Multifocal stroke from tumor emboli.Arch Neurol. 2009; 66: 1174-1175
- Trends in cancer diagnoses among inpatients hospitalized with stroke.J Stroke Cerebrovasc Dis. 2013; 22: 1146-1150
- Combining immunotherapy and targeted therapies in cancer treatment.Nat Rev Cancer. 2012; 12: 237-251
- Epidemiologic signatures in cancer.N Engl J Med. 2019; 381: 1378-1386
- Cancer statistics, 2021.CA Cancer J Clin. 2021; 71: 7-33
- Annual report to the nation on the status of cancer, part 1: National cancer statistics.J Natl Cancer Inst. 2021; 113: 1648-1669
- Higher lung cancer incidence in young women than young men in the united states.N Engl J Med. 2018; 378: 1999-2009
- Trends and factors associated with concordance between international classification of diseases, ninth and tenth revision, clinical modification codes and stroke clinical diagnoses.Stroke. 2019; 50: 1959-1967
Medicare Cf, Services M. Icd-10-cm official guidelines for coding and reporting fy 2020 (october 1, 2019-september 30, 2020). 2020
- Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data.Med Care. 2004; : 355-360
Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M, et al. Seer cancer statistics review, 1975-2018. Bethesda: National cancer institute. 2021. 2021
- Risk of arterial thromboembolism in patients with cancer.J Am Coll Cardiol. 2017; 70: 926-938
- Adjusting for multiple testing—when and how?.J Clin Epidemiol. 2001; 54: 343-349
- Screening for prostate cancer: US preventive services task force recommendation statement.Ann Intern Med. 2008; 149: 185-191
- Screening for prostate cancer: US preventive services task force recommendation statement.Ann Intern Med. 2012; 157: 120-134
- Age and cancer risk: a potentially modifiable relationship.Am J Prev Med. 2014; 46: S7-S15
- Cancer therapy–associated thrombosis.Arterioscler Thromb Vasc Biol. 2021; 41: 1291-1305
- Carotid stenosis after radiotherapy for nasopharyngeal carcinoma.Arch Otolaryngol. 2000; 126: 517-521
- Association between immune checkpoint inhibitors with cardiovascular events and atherosclerotic plaque.Circulation. 2020; 142: 2299-2311
- Cancer and embolic stroke of undetermined source.Stroke. 2021; 52: 1121-1130
- Clinical manifestation of cancer related stroke: retrospective case–control study.J Neurooncol. 2013; 111: 295-301
- Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association.Stroke. 2019; 50: e344-e418
- Temporal trends in the use of acute recanalization therapies for ischemic stroke in patients with cancer.J Stroke Cerebrovasc Dis. 2019; 28: 2255-2261
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.
