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J Intern Med. 2014 May;275(5):494-505. doi: 10.1111/joim.12165. Epub 2013 Dec 21.

An emerging double burden of disease: the prevalence of individuals with cardiovascular disease and cancer.

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Department of Social and Behavioural Sciences, Harvard School of Public Health, Harvard University, Boston, MA, USA.



Cardiovascular disease (CVD) and cancer are the two leading causes of death in the United States; at the same time, the number of survivors is increasing as therapies continue to improve. The primary objective of this study is to determine the prevalence and characteristics of individuals affected by both CVD and cancer.


We conducted a prevalence study using the 2009 and 2010 national Behavioural Risk Factor Surveillance System population survey. Data from a random sample of individuals (aged 25-99 years) from all states were collected. All participants provided information regarding their CVD and cancer status. Multivariable regression identified associations between participants' characteristics and the prevalence of double disease burden.


Amongst 442,964 study participants, the overall prevalence rates were 11% for CVD and 15% for cancer; 3% of participants reported being survivors of both CVD and cancer. The prevalence of CVD+cancer increased twofold by 65 years of age (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.3-2.5) and doubled again at ≥75 years (OR 4.9, 95% CI 4.6-5.1) and was higher amongst men (OR 1.6, 95% CI 1.6-1.7), multiracial individuals (OR 1.8, 95% CI 1.5-2.0) and those without a high school diploma (OR 1.3, 95% CI 1.2-1.4). Amongst individuals with CVD, 25% also reported having cancer, whilst 19% of all cancer survivors reported having CVD.


The prevalence of the double burden of disease increased with age; this is particularly important as the 'baby boomers' reach this high-risk age group. Future studies should explore potential common upstream or downstream mechanisms of CVD and cancer as well as public health strategies to cope with the double burden of disease.


cancer; cardiovascular disease; multimorbidity; prevalence

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