Ischemic heart disease as a competing cause of death among patients with lung cancer in the United States: A multiple cause-of-death analysis, 1999–2023.

Abstract

11163 Background: Despite improvement in lung cancer prevention, early diagnosis & management, Ischemic heart disease (IHD) has become a major concurrent cause of mortality in lung cancer. Population level evidence on long term deaths due to IHD & lung cancer especially across sex & racial groups are lacking. Identification of these trends is necessary for cardio-oncology risk stratification & promote equitable survivorship care. Methods: We used the CDC WONDER Online Database to obtain mortality data for IHD & Lung Cancer from 1999-2023 from patients aged 45-85 & above. We used current final multiple cause of death data from 1999-2020 & 2018-2023. We used ICD-10 codes I20-I25 for IHD & C33-34 for Lung cancer. Data were stratified by Race (Non-Hispanic [NH] American Indian or Alaska Native, NH Asian or Pacific Islander, NH Black or African American, NH White, Hispanic or Latino), sex (male & female) and age groups (45-85+). We calculated age-adjusted mortality rates (AAMR) per 100,000 population based on the 2000 US standard population. Temporal mortality trends were analyzed using Joinpoint regression. (P < 0.05). Results: From 1999-2023, AAMR from lung cancer & IHD decreased in most demographic groups. Males had higher AAMR than females, with mortality decreasing from 20.3 to 10.6 per 100,000, compared with a decline from 6.8 to 4.6 per 100,000 among females. Joinpoint regression identified substantial reduction among males from 1999-2010 (annual percent change [APC] −2.35%, p < 0.05) & 2010-2016 (APC −5.45%, p < 0.05), followed by stabilization. Among females, declines were observed from 2005-2012 (APC −2.76%, p < 0.05) & 2012-2015 (APC −7.35%, p < 0.05), with a nonsignificant plateau thereafter. NH Black exhibited higher AAMRs despite significant declines from 2005-2018 (APC −4.11%, p < 0.05). NH White showed persistent declines from 1999-2017, followed by a marginal increase during 2017-2021. Hispanic & Asian or Pacific Islander individuals maintained the lowest AAMRs, with decreasing trends & brief late-2010s increases in select subgroups, while American Indian or Alaska Native individuals exhibited greater year-to-year variability without statistically significant joinpoints. Conclusions: During 1999-2023, mortality from IHD & lung cancer decreased significantly in the US. Males & NH Black experienced a major disease burden. Recent improvement in death trends among the select patient population showed appropriate cardiovascular risk management in survivors with lung cancer. This analysis highlighted the importance of cardio-oncology care models & precision-guided, equity-driven interventions to decrease cardiovascular mortality among patients with lung cancer.