Age-specific cardiovascular disease-related mortality among patients with major gastrointestinal cancers - A SEER population-based study

Sep 24, 2026

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Age-specific cardiovascular disease (CVD)-related mortality risk remains incompletely characterized, particularly for major gastrointestinal cancers. A retrospective cohort study analyzed colorectal, pancreatic, hepatocellular, gastric, and esophageal cancer patients from the SEER registry (2000–2015). Using standardized mortality ratio (SMR), competing risk regression, and restricted cubic spline models, the study assessed temporal trends and age patterns. CVD-related mortality decreased over time overall, with older patients predominating, and all cancer groups showed higher mortality than the general U.S. population.

LanguageEnglish

CategoryHealthcare

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Introduction

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DOI: 10. 1002/cam4 .6305 RESEAR CH ARTICLE Age-specific cardiovascular disease-related mortality among patients with major gastrointestinal cancers: A SEER population-based study Gen Liu | Bo-fang Zhang Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China Correspondence Bo-fang Zhang, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute of Wuhan University, Wuhan, 430000, Hubei Province, China. Email: [2014203020018@whu.edu.cn](2014203020018@whu.edu.cn) Funding information National Natural Science Foundation of China, Grant/Award Number: 82100287; Natural Science Foundation of Hubei Province, Grant/Award Number: 2021CFB110 Abstract Background: Studies have reported age as a risk factor for cardiovascular disease (CVD)-related mortality; however, only a few studies have focused on the relationship between age and CVD-related mortality, especially among major gastrointestinal cancers. Method: The present retrospective cohort enrolled patients with colorectal, pancreatic, hepatocellular, gastric, and esophageal cancer between 2000 to 2015 from the Surveillance, Epidemiology and End Results Registry (SEER) . Standardized mortality ratio (SMR), competing risk regression, and restricted cubic spline (RCS) analyses were used in our study. Results: We analyzed 576,713 patients with major gastrointestinal cancers (327,800 patients with colorectal cancer, 93,310 with pancreatic cancer, 69,757 with hepatocellular cancer, 52,024 with gastric cancer, and 33,822 with esophageal cancer). Overall, CVD-related mortality gradually decreased every year, and the majority were older patients. All cancer patients had a higher CVD-related mortality rate than the general U.S. population. The adjusted sub-hazard ratios for middle-aged with colorectal cancer, pancreatic cancer, hepatocellular cancer, gastric cancer, and esophageal cancer were 2.55 (95% CI: 2.15–3.03), 1.77 (95% CI: 1.06–2.97), 2.64 (95% CI: 1.60–4. 36), 2.15 (95% CI: 1.32–3. 51), and 2.28 (95% CI: 1.17–4.44), respectively. The adjusted sub-hazard ratios for older patients with colorectal cancer, pancreatic cancer, hepatocellular cancer, gastric cancer, and esophageal cancer were 11.23 (95% CI: 9.50–13.27), 4.05 (95% CI: 2.46–6.66), 4.47 (95% CI: 2.72–7. 35), 7.16 (95% CI: 4.49–11.41), and 4.40 (95% CI: 2.28–8.48), respectively. A non-linear relationship between age at diagnosis and CVD-related mortality was found in colorectal cancer, pancreatic cancer, and esophageal cancer; their reference ages were 67, 69, and 66years old, respectively. Conclusion: This study demonstrated that age was a risk factor for CVD-related mortality among major gastrointestinal cancers. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. KEYWORDS age, cardiovascular disease, major gastrointestinal cancers, mortality 1 | INTRODUCTION Gastrointestinal cancers are an umbrella term for cancer originating from the stomach, esophagus, pancreas, hepatobiliary system, large intestine (colorectal and anal regions), and small intestine,1,2 with an estimated number of new cases in 2020 of 5,026,243, accounted for 27 .8% of the global incidence of cancer and 35.8% of all cancer-related deaths in 2020.3 By 2040, it is estimated that 8,051,490 new cases will be (27.9% of the global incidence of cancer), and 5,909,501 deaths (36 . 5% of all cancer-related deaths) .4 In the past two decades, there has been an improved clinical outcome for most cancer with the advancement of early diagnosis and treatment.5 The increased life expectancy of cancer survivors has also led to a higher occurrence of cardiovascular d

FAQs

What data source and study design were used to assess CVD-related mortality by age?

The study used a retrospective cohort design and SEER registry data covering colorectal, pancreatic, hepatocellular, gastric, and esophageal cancer patients from 2000 to 2015.

Which statistical methods evaluated the association between age and CVD-related mortality?

Standardized mortality ratio (SMR), competing risk regression, and restricted cubic spline (RCS) analyses were used to evaluate mortality risk and potential non-linear age relationships.

What overall age-related pattern in CVD-related mortality was reported?

CVD-related mortality decreased gradually each year overall, while the majority of cases were older patients; cancer patients also had higher CVD-related mortality than the general U.S. population.

Sep 24, 2026

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