{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:35:19Z","timestamp":1777890919782,"version":"3.51.4"},"reference-count":68,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advances in cancer therapy have improved survival, but cardiovascular disease (CVD) is now the leading non\u2010cancer cause of death among survivors. Specialized cardio\u2010oncology care mitigates risk, yet access remains limited outside of urban academic centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) 17 Registries (2000\u20132021), including 6,467,098 individuals with first primary malignancies. Outcomes were CVD\u2010specific mortality, estimated using standardized mortality ratios (SMRs) and excess absolute risks (EARs). Exposures were county\u2010level urban\/rural status, persistent poverty status, and racial composition. Cancer\u2010specific analyses were additionally performed for major cancer sites to assess heterogeneity in county\u2010level disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow\u2010up, 394,540 CVD deaths occurred (SMR\u2009=\u20091.11; 95% CI\u2009=\u20091.11, 1.11). Survivors in rural counties (SMR\u2009=\u20091.27), counties with persistent poverty (SMR\u2009=\u20091.35), and those with the highest quartile of Black residents (SMR\u2009=\u20091.15) had significantly higher CVD mortality compared with the general population. The highest risk was observed in rural counties with persistent poverty (SMR\u2009=\u20091.53). Across county groups, CVD mortality peaked within the first year after diagnosis and remained elevated for over a decade in disadvantaged communities. Substantial heterogeneity was found across cancer types in county\u2010level disparities in CVD mortality, with the largest EAR differences observed among survivors of lung and bronchus cancer, followed by corpus uteri, prostate, and urinary bladder cancers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cancer survivors experience substantial and sustained excess CVD mortality, with the greatest disparities in rural and persistently impoverished counties. These findings highlight the need to integrate cardiovascular surveillance into survivorship care and expand access to cardio\u2010oncology services in socially vulnerable communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71675","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:55:44Z","timestamp":1773010544000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Mortality Risk After Cancer Diagnosis by County\u2010Level Characteristics in the United States 2000\u20132021"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5085-1589","authenticated-orcid":false,"given":"Yenan","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida  Gainesville Florida USA"},{"name":"UF Health Cancer Center  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0649-9503","authenticated-orcid":false,"given":"Ryan","family":"Suk","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing Emory University  Atlanta Georgia USA"},{"name":"Department of Health Policy and Management, Rollins School of Public Health Emory University  Atlanta Georgia USA"},{"name":"Winship Center for Cancer Health Equity Research, Winship Cancer Institute Emory University  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yueh\u2010Yun","family":"Lin","sequence":"additional","affiliation":[{"name":"Center for Health Data Science &amp; 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