Functional-cardiometabolic dual burden among U.S. gynecologic cancer survivors: a national health interview survey study, 2019–2024

Gynecologic cancer survivors may experience coexisting mobility difficulties and cardiometabolic multimorbidity, but their joint burden and its distinction from other female cancer survivorship remain incompletely characterized. We analyzed public-use National Health Interview Survey Sample Adult data from 2019 to 2024. The 2020 Sample Adult Partial file and its dedicated weight were used to avoid repeated 2019–2020 interviews. Adult women were classified as having no cancer history, non-gynecologic cancer, or cervical, ovarian, and/or uterine cancer. Dual burden required at least one reported walking/step-related difficulty and at least two of six cardiometabolic conditions. Missing component responses were handled using explicit three-valued logic. Survey-weighted, design-based modified Poisson models estimated adjusted prevalence ratios (PRs); logistic models provided complementary odds ratios (ORs). Among 88,194 complete-case participants (76,450 without cancer; 9,778 other cancer survivors; 1,966 gynecologic cancer survivors), 16,545 had dual burden. Weighted prevalence was 13.6% (95% confidence interval [CI], 13.2–14.0), 30.1% (28.9–31.2), and 33.4% (30.7–36.2), respectively. In the fully adjusted primary model, gynecologic cancer survivorship was associated with greater dual-burden prevalence versus no cancer (PR 1.404, 95% CI 1.291–1.528; P < 0.001) and other cancer survivorship (PR 1.227, 95% CI 1.121–1.343; P < 0.001). However, the gynecologic-versus-other-cancer contrast was sensitive to the functional definition and was not statistically significant when at least two functional difficulties were required (PR 1.138, 95% CI 0.974–1.330; P = 0.104). The complementary OR versus no cancer was 1.750 (95% CI 1.509–2.030). Gynecologic cancer survivorship was cross-sectionally associated with a higher joint functional-cardiometabolic burden than no cancer history. The contrast with other cancer survivors was present under the primary definition but was not statistically significant under the stricter multiple-difficulty definition. Integrated mobility and cardiometabolic assessment may be useful, but the composite requires external validation and the findings do not establish causation.