Advertisement

Trends in age and sex-specific prevalence of cancer and cancer subtypes in acute ischemic stroke from 2007-2019

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ahmad FB
        • Anderson RN.
        The leading causes of death in the US for 2020.
        JAMA. 2021; 325: 1829-1830
        • Navi BB
        • Iadecola C.
        Ischemic stroke in cancer patients: a review of an underappreciated pathology.
        Ann Neurol. 2018; 83: 873-883
        • Bang OY
        • Chung J-W
        • Lee MJ
        • Seo W-K
        • Kim G-M
        • Ahn M-J
        • et al.
        Cancer-related stroke: an emerging subtype of ischemic stroke with unique pathomechanisms.
        J Stroke. 2020; 22: 1
        • Navi BB
        • Kawaguchi K
        • Hriljac I
        • Lavi E
        • DeAngelis LM
        • Jamieson DG.
        Multifocal stroke from tumor emboli.
        Arch Neurol. 2009; 66: 1174-1175
        • Sanossian N
        • Djabiras C
        • Mack WJ
        • Ovbiagele B.
        Trends in cancer diagnoses among inpatients hospitalized with stroke.
        J Stroke Cerebrovasc Dis. 2013; 22: 1146-1150
        • Vanneman M
        • Dranoff G.
        Combining immunotherapy and targeted therapies in cancer treatment.
        Nat Rev Cancer. 2012; 12: 237-251
        • Welch HG
        • Kramer BS
        • Black WC.
        Epidemiologic signatures in cancer.
        N Engl J Med. 2019; 381: 1378-1386
        • Siegel RL
        • Miller KD
        • Fuchs HE
        • Jemal A.
        Cancer statistics, 2021.
        CA Cancer J Clin. 2021; 71: 7-33
        • Islami F
        • Ward EM
        • Sung H
        • Cronin KA
        • Tangka FK
        • Sherman RL
        • et al.
        Annual report to the nation on the status of cancer, part 1: National cancer statistics.
        J Natl Cancer Inst. 2021; 113: 1648-1669
        • Jemal A
        • Miller KD
        • Ma J
        • Siegel RL
        • Fedewa SA
        • Islami F
        • et al.
        Higher lung cancer incidence in young women than young men in the united states.
        N Engl J Med. 2018; 378: 1999-2009
        • Chang TE
        • Tong X
        • George MG
        • Coleman King SM
        • Yin X
        • O'Brien S
        • et al.
        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
      1. Medicare Cf, Services M. Icd-10-cm official guidelines for coding and reporting fy 2020 (october 1, 2019-september 30, 2020). 2020

        • Southern DA
        • Quan H
        • Ghali WA.
        Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data.
        Med Care. 2004; : 355-360
      2. 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

        • Navi BB
        • Reiner AS
        • Kamel H
        • Iadecola C
        • Okin PM
        • Elkind MS
        • et al.
        Risk of arterial thromboembolism in patients with cancer.
        J Am Coll Cardiol. 2017; 70: 926-938
        • Bender R
        • Lange S.
        Adjusting for multiple testing—when and how?.
        J Clin Epidemiol. 2001; 54: 343-349
        • Force* UPST
        Screening for prostate cancer: US preventive services task force recommendation statement.
        Ann Intern Med. 2008; 149: 185-191
        • Moyer VA
        • Force* UPST
        Screening for prostate cancer: US preventive services task force recommendation statement.
        Ann Intern Med. 2012; 157: 120-134
        • White MC
        • Holman DM
        • Boehm JE
        • Peipins LA
        • Grossman M
        • Henley SJ.
        Age and cancer risk: a potentially modifiable relationship.
        Am J Prev Med. 2014; 46: S7-S15
        • Grover SP
        • Hisada YM
        • Kasthuri RS
        • Reeves BN
        • Mackman N.
        Cancer therapy–associated thrombosis.
        Arterioscler Thromb Vasc Biol. 2021; 41: 1291-1305
        • Cheng SW
        • Ting AC
        • Lam LK
        • Wei WI.
        Carotid stenosis after radiotherapy for nasopharyngeal carcinoma.
        Arch Otolaryngol. 2000; 126: 517-521
        • Drobni ZD
        • Alvi RM
        • Taron J
        • Zafar A
        • Murphy SP
        • Rambarat PK
        • et al.
        Association between immune checkpoint inhibitors with cardiovascular events and atherosclerotic plaque.
        Circulation. 2020; 142: 2299-2311
        • Navi BB
        • Kasner SE
        • Elkind MS
        • Cushman M
        • Bang OY
        • DeAngelis LM.
        Cancer and embolic stroke of undetermined source.
        Stroke. 2021; 52: 1121-1130
        • Kim J-M
        • Jung K-H
        • Park KH
        • Lee S-T
        • Chu K
        • Roh J-K
        Clinical manifestation of cancer related stroke: retrospective case–control study.
        J Neurooncol. 2013; 111: 295-301
        • Powers WJ
        • Rabinstein AA
        • Ackerson T
        • Adeoye OM
        • Bambakidis NC
        • Becker K
        • et al.
        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
        • Chatterjee A
        • Merkler AE
        • Murthy SB
        • Burch JE
        • Chen ML
        • Gialdini G
        • et al.
        Temporal trends in the use of acute recanalization therapies for ischemic stroke in patients with cancer.
        J Stroke Cerebrovasc Dis. 2019; 28: 2255-2261