Genital cancer mortality in comorbid vs. non-comorbid populations: A nationwide trend analysis.

Abstract

e23071 Background: Genital cancers (GCs) remain a critical public health issue, with comorbidities such as hypertension (HTN) and diabetes significantly impacting outcomes. This study investigates comparative mortality trends in GCs with and without comorbid HTN and diabetes in U.S. adults aged 35 years and older. Methods: Data from 1999-2022 was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMR) and annual percentage changes (APC) were calculated using Joinpoint regression. Results: Between 1999 and 2022, 277,938 GC deaths occurred with comorbid HTN and diabetes compared to 1,817,017 without these comorbidities. AAMRs for GCs with comorbidities increased significantly from 39.23 in 1999 to 68.34 in 2022, while AAMRs for GCs without comorbidities declined from 424.63 to 319.56. Men consistently had higher AAMRs than women in both groups (Men: 96.01 vs Women: 25.57 and Men: 513.59 vs Women: 264.00). NH Blacks had the highest average APC for GCs both with (7.12) and without (-0.94) comorbidities, though the burden of GCs-related mortality was significantly lower without comorbidities. Mortality rates were highest in the 85+ age group in both cohorts. Geographical analysis revealed the highest overall AAMR in the Midwest, with 53.77 for GCs with comorbidities and 352.6 for those without. Non-metropolitan areas accounted for 20.4% of deaths (AAMR: 43.82 to 75.45; APC: 2.37) in GCs with comorbidities, while metropolitan areas accounted for 79.6% (AAMR: 38.18 to 62.25; APC: 2.08), both demonstrating increasing mortality. For GCs without comorbidities, non-metropolitan areas had 18.4% of deaths (AAMR: 444.8 to 346.76; APC: -1.36), and metropolitan areas had 81.6% (AAMR: 419.96 to 315.75; APC: -1.47), both showing a decline over time. Conclusions: Mortality trends for GCs with comorbid HTN and diabetes are rising, in stark contrast to declining trends for GCs without these comorbidities. Disparities by sex, race, age, and geography highlight the need for targeted interventions and equitable access to care, particularly for high-risk populations. Deaths and average annual percent change (AAPC) per million for genital cancers with and without hypertension (HTN) & diabetes mellitus (DM) among adults in the U.S between 1999 and 2022. Genital cancer with HTN & DM Genital cancer without HTN & DM Variable Deaths (n) AAPC (95% CI) Deaths (n) AAPC (95% CI) Overall 277938 2.51 (1.17 to 3.87) 1817017 -1.18 (-1.36 to -0.99) Female 78889 2.76 (1.65 to 3.88) 773749 -0.57 (-0.74 to -0.4) Male 199049 1.97 (0.6 to 3.36) 1043268 -2.05 (-2.27 to -1.84) African American 49058 1.52 (-0.38 to 3.46) 262205 -1.62 (-1.83 to -1.42) White 203876 2.85 (1.67 to 4.05) 1395634 -1.04 (-1.24 to -0.84) Hispanic 17080 1.27 (0.3 to 2.26) 109184 -0.94 (-1.54 to -0.33) South region 100672 3.41 (2.16 to 4.67) 650651 -1.11 (-1.29 to -0.93) 75-84 years of age 100893 1.99 (0.6 to 3.4) 574303 -1.52 (-1.74 to -1.31)