Rural-urban disparities in cardiovascular and other competing risk of death among cancer patients

Rural-urban disparities in noncancer death risk among cancer patients in the United States. AAMR, age-adjusted mortality rates; SMR, standardized mortality ratio. • Cancer patients have higher competing risks of death, especially cardiovascular disease(CVD)-related deaths. • The rural cancer patients have higher risks of noncancer death, especially CVD-related deaths, than those in the urban areas. • Rural-urban disparities in noncancer death burden may be partly mediated by a median household income, in addition to the SEER stage, regardless of race. • There is an urgent need to invest more in and prioritize the management and prevention of non-cancer deaths (especially cardiovascular disease) among rural cancer patients. • The study offers a nationally representative analysis of the US population through the SEER database, providing broader implications for public health and policy. Rural-urban disparity of cancer is a major public health problem, with an unclear gap in noncancer death. It is important to evaluate rural–urban disparities in cardiovascular diseases (CVDs) and other competing death among cancer patients. Observing urban–rural disparities and trends in noncancer deaths in the U.S. cancer population. To address rural–urban disparities, we used proportions of deaths, age-adjusted mortality rates (AAMR), cumulative mortality rates, subdistribution hazard ratio (sHR), standardized mortality ratios (SMRs), absolute excess risks (AERs) and mediation analysis. Between 1990 and 2017, there were 2,022,482 patients of 24 cancer sites, with a median follow-up of 11·8 years. Rural proportions of noncancer and CVD deaths in cancer patients were higher than urban ones. Rural AAMR of noncancer and CVD deaths surpassed urban one in cancer patients, who had higher cumulative mortality rates than urban counterparts in noncancer (sHR:1·21, 95 % confidence interval CI:1·19-1·22), CVDs (sHR:1·25, 95 % CI: 1·23-1·28), diabetes mellitus (sHR:1·24, 95 % CI:1·15-1·34), Alzheimer’s disease (sHR:1·30, 95 % CI:1·21-1·39), pneumonia and influenza (sHR:1·30, 95 % CI:1·21-1·39) and chronic obstructive pulmonary disease and allied cond (sHR:1·32, 95 % CI:1·26-1·39). Compared with the general population, both rural (SMR:4·58, AER:218·03) and urban (SMR: 3·74, AER: 166·61) cancer patients had higher risks of noncancer death. Mediation analyses identified median household income and SEER stages as the mediators. Rural cancer patients had higher risks of noncancer death than urban counterparts, especially CVD-related deaths. Future targeted policy and public health interventions are needed to diminish the rural–urban gap in such death disparities.