Nationwide trends in mortality with concurrent colorectal cancer and chronic ischemic heart disease: A CDC WONDER analysis (1999–2020).

Abstract

e15721 Background: Co-mortality from colorectal cancer (CRC) and chronic ischemic heart disease (CIHD) is increasingly relevant in an aging population, yet contemporary U.S. trend patterns and disparities are incompletely described. Methods: Using CDC WONDER Death data (1999–2020), we identified deaths listing CRC (ICD-10 C18–C20) and CIHD (I25). We calculated age-adjusted mortality rates (AAMRs) per 100,000 using the 2000 U.S. standard population and evaluated temporal changes with Joinpoint regression (annual percent change [APC] and average annual percent change [AAPC]), with stratification by sex, age group, race/ethnicity, U.S. Census region, and urban-rural status. Results: We identified 99,083 deaths with CRC and CIHD listed. Overall, AAMRs declined significantly (AAPC −4.37%, 95% CI −4.83 to −3.92; P < 0.05). Men had higher mortality than women (AAMR 3.10 vs 1.41), and both sexes showed significant overall declines (women AAPC −5.19%, 95% CI −5.93 to −4.46; P < 0.05; men AAPC −4.05%, 95% CI −4.61 to −3.49; P < 0.05). Segmentally, women declined significantly from 1999–2006 (APC −4.72%, P < 0.05) and 2006–2017 (APC −7.27%, P < 0.05), followed by a non-significant incline thereafter. Men similarly declined significantly from 1999–2006 (APC −4.04%, P < 0.05) and 2006–2016 (APC −6.01%, P < 0.05), with a later non-significant reversal. By age, the 45–54 group showed a non-significant upward trend (APC 1.32%, 95% CI −0.05 to 2.70; P = 0.058), while ages 55–64 transitioned from a significant decline through 2017 (APC −3.77%) to a significant increase thereafter (APC 9.76%). Racial/ethnic burdens were highest among non-Hispanic (NH) White (AAMR 2.15) and NH Black individuals (AAMR 1.94), and AAMRs declined significantly across groups (e.g., Asians AAPC −4.34%, P = 0.013; NH Black AAPC −4.34%, P < 0.05; NH White AAPC −4.33%, P < 0.05; and Hispanics AAPC −4.27%, P < 0.05). Regionally, AAMR was highest in the Northeast (2.54) and Midwest (2.37); all regions declined significantly overall (e.g., Northeast AAPC −5.54%, P < 0.05; South AAPC −3.18%, P < 0.05), with a non-significant rebound in the Northeast after 2018. Nonmetropolitan areas had higher AAMR than metropolitan areas (2.47 vs 1.99), and both showed significant overall declines (metro AAPC −4.60%, P < 0.05; nonmetro AAPC −3.26%, P < 0.05). State AAMRs ranged from 0.94 (Utah) to 3.38 (West Virginia). Conclusions: CRC–CIHD co-mortality overall declined substantially from 1999–2020 but has recently plateaued, with concerning midlife increases and persistent rural and regional disparities. These findings support targeted, equity-focused integration of CRC screening/early detection with cardiovascular risk prevention and management, particularly for vulnerable subgroups.