Racial Disparities in Major Adverse Cardiovascular and Cerebrovascular Events Among Hospitalized Patients with Leukemia: A National Analysis
Authors: Uttam Chandani Kanishka , Agrawal Siddharth pravin , Raval Maharshi , Siddiq Sajid , Nadeem Ahmed , Kelkar Amar H. 
Published: December 2024

Introduction:

Leukemia poses significant health challenges beyond its primary impact, including heightened risks for cardiovascular and cerebrovascular events. Major adverse cardiovascular and cerebrovascular events (MACCE), such as acute myocardial infarction (AMI), atrial fibrillation (AF), cerebrovascular accident (CVA), and sudden cardiac death (SCD), are critical complications that can severely affect patient outcomes. Racial disparities in the incidence and outcomes of MACCE have been documented in various diseases, but comprehensive analyses focusing on leukemia patients are lacking. Understanding these disparities is crucial for developing targeted interventions and improving healthcare equity.

Methods:

We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database for the year 2019. Patients with a diagnosis of leukemia, identified using International Classification of Diseases, Tenth Revision (ICD-10) codes, were included in the study. We defined major adverse cardiovascular and cerebrovascular events (MACCE) as the occurrence of any of the following during hospitalization: all-cause in-hospital mortality (ACIHM), acute myocardial infarction (AMI), atrial fibrillation (AF), cerebrovascular accident (CVA), or sudden cardiac death (SCD).

Baseline characteristics of the patients, including demographics, comorbidities, and MACCE outcomes, were collected. To investigate potential racial disparities in MACCE, we stratified the results by patient race/ethnicity. Adjusted odds ratios (aOR) were calculated, and statistical analysis was performed using chi-square tests for categorical variables and analysis of variance (ANOVA) for continuous variables. Statistical significance was determined at a p-value of &lt;0.05.

Results:

Our study included 244,754 patients hospitalized with leukemia. The majority were White (74.7%), followed by Black (9.9%), Hispanic (9.2%), Asian/Pacific Islander (2.7%), Native American (0.5%), and Other (2.9%). We found significant racial disparities in several cardiovascular outcomes.

ACIHM: Compared to White patients, the adjusted odds of dying in the hospital were 1.17 times higher for Hispanic patients (95% CI 1.01-1.36, p=0.04), 1.42 times higher for Asian/Pacific Islander patients (95% CI 1.16-1.75, p=0.001), and 1.41 times higher for patients in the “Other” racial category (95% CI 1.33-1.76, p=0.002).

AMI: Asian/Pacific Islander patients had a 1.48 times higher adjusted odds of having a heart attack (95% CI 1.08-2.02, p=0.01), while Hispanic patients had a 0.68 times lower adjusted odds (95% CI 0.52-0.88, p=0.003), compared to White patients.

AF: Black, Hispanic, Asian/Pacific Islander, and Other race patients all had significantly lower odds of developing atrial fibrillation compared to White patients.

CVA: Black patients had a 1.21 times higher adjusted odds of having a stroke (95% CI 1.06-1.39, p=0.004) compared to White patients.

SCD: Black patients had a 1.75 times higher adjusted odds of sudden cardiac death (95% CI 1.34-2.28, p&lt;0.001) compared to White patients.

Conclusion:

Our study reveals significant racial disparities in MACCE among hospitalized patients with leukemia. Hispanic, Asian/Pacific Islander, and patients categorized as “Other” race experienced higher in-hospital mortality compared to White patients. Additionally, Asian/Pacific Islanders demonstrated an increased risk of AMI, while Black patients faced elevated risks of both CVA and sudden cardiac death (SCD). These findings underscore the need for root cause analyses to understand the underlying mechanisms driving these disparities and, possibly, targeted interventions for disparities that can be redemonstrated, with the ultimate goal of ensuring equitable cardiovascular care for all patients with leukemia.