Mortality trends and persistent disparities among U.S. adults with lung cancer and hypertensive diseases (1999–2023): A nationwide retrospective analysis.

Abstract

e20668 Background: Hypertension is a prevalent comorbidity in patients with lung cancer and may exacerbate cardiovascular vulnerability, treatment-related toxicity, and mortality. However, long-term national mortality trends among individuals with concomitant lung cancer and hypertensive diseases remain poorly characterized. We evaluated temporal trends and sociodemographic disparities in mortality among U.S. adults with lung cancer and hypertensive diseases listed as contributing causes of death. Methods: We conducted a population-based retrospective MCOD analysis using the CDC WONDER database from 1999 to 2023. Adults aged ≥45 years with lung cancer and hypertensive diseases recorded as contributing causes of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Stratified analyses were performed by sex, race/ethnicity, census region, urbanization, age group, state, and place of death. Results: From 1999 to 2023, AAMRs increased nearly threefold, from 22.23 to 61.79 (AAPC 2.57%; 95% CI, 1.98–3.15; p < 0.05). Mortality increased among both males and females, with a notable decline between 2007–2018 followed by a sharp resurgence after 2018. The South experienced the steepest long-term increase, with marked post-2017 acceleration. Nonmetropolitan areas demonstrated faster mortality growth than metropolitan areas. Racial disparities were evident, with the highest increases among American Indian/Alaska Native and White individuals. Older adults exhibited the highest absolute mortality, while middle-aged adults showed the fastest rising trends. During 2018–2023, the highest state-level AAMRs were observed in Mississippi, Oklahoma, and Nebraska. Home deaths increased over time, accounting for 45.3% of deaths in the most recent period. Conclusions: Mortality among U.S. adults with lung cancer and hypertensive diseases has increased substantially over the past two decades, with widening regional, racial, and rural disparities and a concerning post-2018 resurgence. These findings underscore the need for integrated cardio-oncology strategies to mitigate hypertension-related risks in lung cancer care.