Competing Risk of Mortality from COVID-19, Cerebrovascular Diseases, and Ischemic Heart Disease for the Cancer Patients in the United States

Purpose This study investigates the impact of ethnicity, socioeconomic status (SES), and rural-urban disparities on event-free survival (EFS) and cause-specific mortality risks (COVID-19, cerebrovascular diseases [CVD], and ischemic heart disease [IHD]) among cancer patients. Methods A retrospective cohort study used data from the National Cancer Institute (NCI) and the SEER Program. Cumulative incidence analysis and competing risk regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for EFS and cause-specific mortality, adjusted for predictors. Interaction effects evaluated for the potential predictors. Results Among 333,966 cancer patients, mortality rates were 0.47% for COVID-19, 0.26% for CVD, and 0.64% for IHD. Racial disparities were observed, with American Indian/Alaska Native patients having the highest cancer-related comorbidities, while Chinese, Japanese, and Filipino patients had lower risks. Higher SES (median household income >$80,000) was associated with reduced cancer-related comorbidities (HR: 0.79, 95% CI: 0.67–0.92), COVID-19 mortality (HR: 0.57, 95% CI: 0.45–0.72), and CVD mortality (HR: 0.60, 95% CI: 0.45–0.81). However, higher SES in rural regions (RUCC2) was linked to increased CVD mortality (HR: 1.60, 95% CI: 1.06–2.41). Rural patients (RUCC4–RUCC5) had significantly higher IHD mortality risks than urban residents (HR: 2.56, 95% CI: 1.87–3.52, HR: 2.41, 95% CI: 1.76–3.30). SES and rural-urban status interactions revealed complex comorbidity patterns for cancer patients. Conclusion The study revealed significant disparities in cancer survival and cause-specific mortality based on race, SES, and geography. These findings help identify vulnerable cohorts for targeted policy measures, interventions, and future research.