Temporal trends and risk factors associated with stroke mortality among cancer patients

Yaman B Ahmed; Amy Shi Nan Feng; Mohammad Alrawashdeh; Asmaa Ellaithy; Shivalika Khanduja; Majd M AlBarakat; Sakhr Alshwayyat; Ken Uchino; Aaron M Gusdon; Sung-Min Cho

doi:10.1016/j.jocn.2025.111249

Temporal trends and risk factors associated with stroke mortality among cancer patients

J Clin Neurosci. 2025 Jun:136:111249. doi: 10.1016/j.jocn.2025.111249. Epub 2025 Apr 18.

Authors

Affiliations

¹ Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Division of Neuroscience Critical Care, Departments of Neurosurgery, Anesthesiology, Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
² Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
³ Faculty of Nursing, Community and Mental Health Nursing, Jordan University of Science & Technology, Irbid, Jordan.
⁴ Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
⁵ Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
⁶ Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
⁷ Division of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
⁸ Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Division of Neuroscience Critical Care, Departments of Neurosurgery, Anesthesiology, Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. Electronic address: csungmi1@jhmi.edu.

PMID: 40252475
DOI: 10.1016/j.jocn.2025.111249

Abstract

Background: This study aimed to explore the risk of stroke death (SD) in cancer patients, estimate rates, and identify risk factors associated with SD.

Methods: In this retrospective study, we used the 17 National Cancer Institute Surveillance, Epidemiology, and End Results registries (2000-2020). A total of 5,922,533 patients diagnosed with their first primary cancer were included. The primary outcome was the standardized mortality ratio (SMR) of SD in cancer patients. Secondary outcomes included SD incidence rates and risk factors. Rates were calculated per 100,000 persons with the annual percentage change (APC).

Results: Among included patients, 56,686 (2.0 %) died due to stroke. Compared to the general population, younger patients (≤39 years) (SMR: 2.31) and patients receiving no treatment (SMR: 1.36) had the highest risk. Cancer types with the fastest-declining SD rates were in the male genital (APC: -13.9 %) and breast (APC: -11.8 %). Older age (hazard ratio [HR]: 1.11, p < 0.001), male sex (HR: 1.06, p < 0.001), and non-white race (HR: 1.13, p < 0.001) were associated with increased risk of SD. Cancers of the nervous system (HR: 3.42, p < 0.001), respiratory (HR: 1.38, p < 0.001), and head and neck (HR: 1.37, p < 0.001) had higher risk of SD vs. breast cancer. Patients with primary chemotherapy (HR: 0.69, p < 0.001) and radiotherapy (HR: 0.69, p < 0.001) demonstrated less risk vs. those without treatment.

Conclusion: SD has declined over the years for both sexes and all cancer types. Older age, non-white race, and certain cancers (nervous system, respiratory system, and head and neck) pose significant risks for SD.

Keywords: Cancer; Risk factors; SEER; Standardized mortality ratio; Stroke mortality.

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Humans
Incidence
Male
Middle Aged
Neoplasms* / complications
Neoplasms* / epidemiology
Neoplasms* / mortality
Registries
Retrospective Studies
Risk Factors
SEER Program
Stroke* / mortality
United States / epidemiology
Young Adult