Cancer and cardiovascular disease are the two most common causes of disease and death in the UK and globally. Importantly, these diseases frequently coexist. This project will focus on people who suffer from the most common cancers and the most common cardiovascular diseases. Previous studies have shown differences in rates of disease and treatments in different ethnic groups, but people with both cancer and cardiovascular disease have not been considered before. Research has also identified inequalities in COVID-19 deaths by ethnic group and many COVID-19 patients had cancer and cardiovascular disease.
We will determine if there are differences between ethnic groups by rates of disease, treatments and outcomes in people who suffer from both cancer and cardiovascular disease. We will use routinely collected electronic health records linking both general practice and hospital data.
First, we will investigate the quality of ethnicity data currently available. Second, we will examine rates of new and existing disease by ethnic group. Third, we will study treatments and the use of healthcare services by ethnic group.
We will also look at the number of coronavirus patients who also had cancer and cardiovascular disease.
This research focuses on the overlap of the two most common diseases in the UK. By identifying differences in disease rates, we may inform future policies for prevention of cancer and cardiovascular disease by highlighting high-risk subgroups. Differences in healthcare provision between ethnic groups may lead to quality improvement in the care of cancer and cardiovascular disease ethnic groups.
Cancer and cardiovascular disease (CVD) have been identified as leading causes of premature death and morbidity in the UK. Cancer and CVD frequently coexist, e.g. treatment for cancer may be associated with heart disease. This project will focus on the following 12 CVDs: cardiac arrest, abdominal aortic aneurysm, transient ischaemic attack, stable angina, intracerebral haemorrhage, myocardial infarction, Ischaemic stroke, heart failure, unstable angina, unheralded coronary death, peripheral arterial disease and subarachnoid haemorrhage. For cancer we will focus on the following 20 most common cancers: oral cavity, oesophageal, stomach, colorectal, liver, pancreas, lung, malignant melanoma, breast, cervix, uterus, ovaries, prostate, kidney, bladder, central nervous system lymphoma, thyroid, non-Hodgkin lymphoma, multiple myeloma and leukaemia. The project will also look at COVID-19 mortality and hospitalisation rates to determine the proportion of patients with cancer and CVD by ethnic group.
Ethnic inequalities have been identified in both cancer and CVD for access to healthcare services and outcomes. Our objective is to assess whether individuals from black and minority ethnic (BME) backgrounds with coexisting cancer and CVD are less likely to have access to healthcare and worse outcomes. We hypothesise that individuals from BME groups with coexisting cancer and CVD have less access to services and worse outcomes than white individuals.
We aim to use linked national electronic health record data to:
- Investigate the quality of ethnicity reporting in cancer and CVD.
- Characterise incidence, prevalence and outcome of coexisting cancer and CVD in BME groups between 2000 and 2020, compared with white individuals.
- Investigate healthcare utilisation by ethnic group in coexisting cancer and CVD
By highlighting the reporting of ethnicity in healthcare data, and the burden of cancer and CVD in BME groups, we will identify health inequalities and inform targeted future policies for public health improvement within communities at risk of cancer and CVD.
The outcomes measured in this study are as follows:
All-cause mortality
Cancer mortality
Cardiovascular mortality
COVID-19 Mortality
COVID-19 Hospitalisations
Healthcare Utilisation (GP visits, clinic appointments, hospital appointments, investigative procedures e.g endoscopy, colposcopy and colonoscopy)
Completeness of ethnicity data
Amitava Banerjee - Chief Investigator - University College London ( UCL )
Zareen Thorlu Bangura - Corresponding Applicant - University College London ( UCL )
Charlotte Manisty - Collaborator - University College London ( UCL )
David Adlam - Collaborator - University of Leicester
Michael Sweeting - Collaborator - University of Leicester
Mohamed Mohamed - Collaborator - University College London ( UCL )
Muhammad Qummer ul Arfeen - Collaborator - University College London ( UCL )
Spiros Denaxas - Collaborator - University College London ( UCL )
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;HES PROMS (Patient Reported Outcomes Measure);ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation