According to research published in Blood Advances, the incidence of cancer-associated thrombosis (CAT) appears to be higher in Black/African American patients and lower in Asian/Pacific Islander patients compared with White patients, and this disparity appears to be driven by the incidence of pulmonary embolism (PE).

“The impact of race/ethnicity on the incidence of [CAT], a common complication in patients with malignancy, has not been well defined,” the study authors wrote in their report.

The researchers conducted a retrospective observational cohort study using the California Cancer Registry, which is linked to the California Patient Discharge Dataset and Emergency Department Utilization database. Using a large cohort of patients with the 13 most common, first primary malignancies between 2005 and 2017, the researchers evaluated the association between race/ethnicity and CAT.  

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The researchers identified 942,109 patients with cancer, of whom 62,003 (6.6%) developed a CAT. Overall, most patients were aged 50 years and older, and stage 4 disease was most common (33.4%) stage at cancer diagnosis. Racial/ethnic differences in neighborhood socioeconomic status (SES) were observed (patients residing in lower SES neighborhoods: Black/African American, 71.9%; Hispanic, 74.9%; White, 46.1%; Asian/Pacific Islander, 50.4%).

The researchers demonstrated that Black/African American patients had the highest 12-month cumulative incidence of CAT for all cancer types, except for myeloma (range, 1.90%-15.00%), compared with the other racial/ethnicity groups. The greatest difference was seen in ovarian cancer, where the 12-month cumulative incidence of CAT was 14.0% (95% CI, 12-16) for Black/African American patients compared with 9.14% (95% CI, 7.68-8.62) in White patients, 8.30% (95% CI, 7.55-9.10) in Hispanic patients, and 6.06% in Asian/Pacific Islander patients. The researchers also found that Asian/Pacific Islander patients had the lowest 12-month cumulative incidence of CAT for all cancer types compared with the other racial/ethnicity groups.

The team demonstrated that the racial/ethnic differences in the incidence of CAT for each tumor type was largely driven by the differences in the incidence of PE.

“We speculate the association of race/ethnicity with incidence of CAT may be partially because of underlying thrombotic predisposition that varies by ancestry, but we also must consider the impact of social determinants of health on our results,” the authors wrote. “In our study, race/ethnicity is likely a surrogate for many factors that are not traditionally measured in biomedical studies and should stimulate further research into the reasons for the association of race/ethnicity with this common and serious complication of cancer, with the goal of reducing potential health inequities.”


Datta T, Brunson A, Mahajan A, Keegan T, Wun T. Racial disparities in cancer-associated thrombosis. Blood Adv. 2022;6(10):3167-3177. doi:10.1182/bloodadvances.2021006209