National mortality trends in colorectal cancer patients with psychiatric and respiratory comorbidities in the United States,1999-2023: A CDC WONDER analysis.

Abstract

e15660 Background: Colorectal Cancer (CRC) is a leading cause of cancer-related deaths in the United States. Comorbidities such as tobacco use disorder, depression, anxiety and chronic pulmonary disease (COPD) may worsen outcomes via delayed diagnosis, reduced treatment tolerance and fragmented care. National long-term mortality trends and disparities among CRC patients with these comorbidities remain poorly defined. Methods: U.S. mortality data (1999-2023) from the CDC WONDER database was analyzed. CRC deaths (ICD-10 : C18-C20) with contributing causes of tobacco use disorder (F17), depression (F32), anxiety (F41) and COPD (J44) were identified. Age adjusted mortality rates were stratified by ten-year age group, sex, region, urbanization and place of death. Individuals aged 35-44 were excluded because of small case counts. Joinpoint regression assessed temporal trends via annual percentage change (APC) and average annual percent change (AAPC). Place of death was analyzed separately. Results: Stratified analyses demonstrated significant increase in colorectal cancer mortality across multiple subgroups.The steepest increases occurred in adults aged 45-54 (AAPC10.1%, p < 0.001), and 55-64 (AAPC 6.0%, p < 0.001) while trends among adults aged 75 and above were modest. Mortality increased in both males (AAPC 2.0%, p = 0.014) and females ( AAPC 2.5%, p = 0.002). Regionally the Midwest (AAPC 3.3%, p < 0.001) and South (AAPC 3.4%, p < 0.001) saw sustained increases, while Northeast remained stable.Nonmetropolitan areas showed greater mortality increase as compared to metropolitan areas ( AAPC 4.1% vs 2.3%, p < 0.001). Most deaths occurred in inpatient hospital settings. Conclusions: Rising mortality among middle-aged CRC patients with psychiatric and respiratory comorbidities , particularly in rural and Southern regions necessitate urgent systemic reform. Integrated oncology models must prioritize medical, psychosocial and outpatient palliative care to ensure survival gains are equitably realized across all geographic and socioeconomic strata.