Demographic and regional trends in combined colorectal cancer and cerebrovascular disease-related mortality in the United States (1999–2023).

Abstract

e15715 Background: Prior studies suggest substantial cerebrovascular disease (CVD) comorbidity among patients with colorectal cancer (CRC). However, national long-term mortality trends involving combined CRC and CVD causes of death remain poorly characterized. This study aimed to analyze demographic and regional patterns trends in combined CRC and CVD- related mortality in the United States (US) from 1999 to 2023. Methods: We analysed CDC WONDER Multiple Cause-of-Death Public Use record death certificates (1999–2023) for adults aged ≥55y. Death certificates listing CRC (ICD 10: C18-20) and CVD (ICD-10: I60-I69) as either contributing or underlying causes of death were identified. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated and stratified by year, sex, race, census region, state, and metropolitan status. Temporal trends were assessed using Joinpoint regression to estimate the annual percent change (APC) with 95% confidence interval (CI). Results: A total of 47,638 deaths listing CRC and CVD occurred during study period. AAMR declined from 4.51 in 1999 to 1.96 in 2020 (APC -3.95%; 95% CI -4.60 to -3.30), with a rapid early reduction from 1999–2016 (APC −5.64%; 95% CI -5.95 to -5.32), followed by a modest rebound from 2016–2021 (APC +3.82%; 95% CI 0.30 to 7.48), and a subsequent stabilization from 2021-2023 (APC −2.99%; 95% CI -12.7 to 7.79). Males had higher AAMR than females (3.23 vs 2.29), while females experienced a faster decline in mortality [APC −4.14%; 95% CI -4.81 to -3.45 vs APC −3.84%; 95% CI -4.45 to -3.22) [Table]. Black individuals had the highest AAMR (3.61), followed by White (2.48), Asian/Pacific Islander (1.72), and American Indian/Alaska Native populations (1.69), with Asian/Pacific Islanders demonstrating the steepest decline (APC −5.04%; 95% CI -6.03 to -4.03). Regionally, Midwest had the highest AAMR (2.89), while the Northeast showing the steepest decline (APC −4.64%, 95% CI -5.20 to -4.08). Non-metropolitan areas had higher mortality rates than metropolitan areas (AAMR 3.30 vs 2.55). Conclusions: Although combined CRC and CVD- related mortality among older adults has declined substantially over the past two decades, persistent sociodemographic and regional disparities remain. These findings may highlight the potential importance of integrating cardiovascular risk assessment and prevention strategies into CRC survivorship and cardio-oncology care models. Annual percentage change in combined colorectal cancer and cerebrovascular disease related mortality among patients aged ≥ 55 in the US (1999-2023). Variable Deaths Annual Percentage Change (95% CI) Overall 47,638 -3.95 ( -4.60 to - 3.30) Male 22,947 -3.84 (-4.45 to -3.22) Female 24,691 -4.14 (-4.81 to -3.45) White 40,416 -3.89 (-4.54 to -3.24) Black or African Americans 5,985 -3.82 (-4.56 to -3.08) Asian or Pacific Islander 938 -5.04 (-6.03 to -4.03)