Mortality trends: Colorectal carcinoma associated with tobacco use as a cause of death in the United States—A CDC WONDER analysis (1999-2023).

Abstract

e15659 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality in the United States (U.S.) Tobacco use is a modifiable risk factor for CRC and can carry a 14-18% higher risk of CRC compared to non-smokers. Despite this recognized association, contemporary analyses examining long-term national trends and the relationship between tobacco use and CRC mortality remain limited. Methods: Mortality data were obtained from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database to assess colorectal cancer (CRC; International Classification of Diseases (ICD-10) codes C18–C20) and tobacco-related deaths (ICD-10 code F17) among adults aged ≥25 years in the United States. Annual age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the direct method and standardized to the 2000 U.S. standard population. Analyses were stratified by year, sex, race/ethnicity, and U.S. census region. Chronological trends in mortality were assessed using Joinpoint regression analysis to estimate average annual percent changes (AAPCs) and corresponding 95% confidence intervals (CIs). Statistical significance was defined as p value < 0.05. Results: From 1999–2023, 71,007 CRC deaths were linked to tobacco use. Overall AAMR rose from 0.13 in 1999 to 1.67 in 2023 (APC: 4.88; 95% CI: 3.60–7.04). Men were found to have higher AAMRs than women (1999: 0.21 vs 0.07; 2023: 2.39 vs 1.08). Racial and ethnic disparities were also evident. Non-Hispanic Whites had the highest mortality, followed by Non-Hispanic Blacks, then Hispanics/Latinos (2023 AAMRs: 1.94, 1.58, and 0.73, respectively). Marked regional variation was also observed, with the Midwest exhibiting the highest mortality rates since 2008 (2023 AAMRs: Midwest, 2.35; South, 1.77; West, 1.30; Northeast, 1.23 per 100,000). State-level variation was noted: North Dakota led in 1999–2020, Kentucky in 2021–2023, while California had the lowest rates. Conclusions: In this multivariate analysis from 1999-2023, tobacco use was shown to have significant impact on CRC mortality. The CDC-WONDER database demonstrated clear disparities by region, sex and ethnic backgrounds. Despite advancements in colorectal cancer screening and treatment, the rising burden of tobacco related CRC mortality underscores the persistent and preventable impact of tobacco use.