Temporal Trends in the Frequency of Concomitant Cancer and Cerebrovascular Disease Diagnoses in the United States.

Background And Objectives Cancer is associated with vascular disease. Modern cancer treatments, particularly targeted agents and immunotherapy, have extended survival from cancer. We aimed to determine whether the co-prevalence of cancer and cerebrovascular disease diagnoses among outpatients has increased over time along with these advances.Methods This was a time-series cross-sectional analysis of outpatient visits in the US National Ambulatory Medical Care Survey from 2005 to 2019. The primary cohort included patient visits with a diagnosis of cerebrovascular disease (ischemic or hemorrhagic stroke or TIA). We used joinpoint regression to evaluate temporal trends in the frequency of concomitant cancer diagnoses during the study period. We used logistic regression, adjusting for demographics and stroke risk factors, to assess the relationship between survey year and cancer diagnoses.Results After applying sampling weights, this analysis represented an estimated 245,093,640 visits by patients with a cerebrovascular disease diagnosis. The mean patient age for the overall cohort was 69.4 years (SD, 15.9), and 51.0% were women. Among patients with cerebrovascular disease, 27,294,617 visits (11.1%) included a concomitant diagnosis of cancer. The percentage of visits listing a concomitant cancer diagnosis increased from 7.7% (95% CI 4.6%-10.7%) in 2005 to 15.3% (95% CI, 6.1%-24.5%) in 2019. Joinpoint regression analysis demonstrated a significant increase in cancer diagnoses from 2005 to 2019, with an annual percentage change of 3.5% (95% CI, 0.2%-6.9%). In multivariable logistic regression analysis, the co-prevalence of cancer and cerebrovascular disease increased linearly over time (adjusted odds ratio per year, 1.04; 95% CI, 1.00-1.08).Discussion From 2005 to 2019, the proportion of US ambulatory visits with concomitant diagnoses of cerebrovascular disease and cancer steadily increased from 7.7% to 15.3%. Because data on the timing of diagnoses are unavailable in NAMCS, this analysis could not determine whether these diagnoses were related, and which came first. Future population-based studies including data on the timing and etiology of stroke and cancer diagnoses are needed to better elucidate the potential causal link between these diseases.