Emerging demographic and geographic disparities in cerebrovascular mortality among U.S. patients with colorectal cancer: A CDC WONDER analysis, 1999–2023.

Abstract

e15730 Background: Colorectal cancer (CRC) is the third most common malignancy globally, with rising incidence in adults under 50. Stroke, a leading cause of death, frequently co-occurs with CRC due to hypercoagulability, elevated D-dimer, genetic predisposition, and cancer therapies. CRC-related ischemic stroke (CRCIS) is associated with worse prognosis, underscoring the need to understand mortality trends. We evaluated national trends in cerebrovascular mortality among CRC patients in the U.S. from 1999–2023, focusing on demographic and geographic disparities. Methods: We conducted a population-based cohort study using the CDC WONDER database (1999–2023) to identify adults ≥45 years with CRC (ICD-10: C18–C20) and cerebrovascular disease (ICD-10: C160–C169) as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) were calculated via Joinpoint Regression. Analyses were stratified by year, age, sex, race/ethnicity, U.S. census region, and urbanization. Results: Among 48,527 decedents, overall AAMR declined from 1999–2015 (APC: -5.59%; 95% CI: -5.93 to -5.25; P < 0.0001), followed by a modest increase from 2015–2023 (APC: 1.77%; 95% CI: 0.58–2.98; P = 0.006). Females showed a faster increase (2016–2023; APC: 3.12%; 95% CI: 0.79–5.50; P = 0.01) than males (2017–2023; APC: 2.20%; 95% CI: 0.33–4.10; P = 0.02). Adults aged 45–64 experienced the steepest rise (2016–2023; APC: 9.48%; 95% CI: 6.52–12.51; P < 0.0001), whereas trends in those ≥65 remained stable. Racial disparities emerged with significant increases among Black (2018–2023; APC: 6.79%; 95% CI: 2.04–11.76; P = 0.007) and Hispanic populations (2018–2023; APC: 7.87%; 95% CI: 0.83–15.41; P = 0.03). Geographically, the Midwest exhibited the most pronounced rise (2016–2023; APC: 2.32%; 95% CI: 0.82–3.85; P = 0.004), and non-metropolitan areas showed significant increases (APC: 4.15%; 95% CI: 1.85–6.50; P = 0.002), while metropolitan trends were stable. Conclusions: After long-term declines, cerebrovascular mortality among CRC patients has risen since 2015, disproportionately affecting middle-aged adults, women, Black and Hispanic populations, and residents of rural and Midwestern areas. These emerging disparities warrant targeted research and interventions to improve outcomes in high-risk subgroups.