Projected burden of lung cancer and tobacco usage among older adults ≥ 65 in the United States: A CDC WONDER forecasting analysis, 1999–2035.

Abstract

e20083 Background: Lung cancer and tobacco use are closely linked, with smoking responsible for most cases. Evaluating long-term mortality trends related to lung cancer among tobacco users is essential to assess the impact and limitations of public health efforts. This study examines lung cancer mortality trends among U.S. adults aged ≥65 years, stratified by demographic and geographic factors. Methods: We performed a retrospective analysis of CDC WONDER mortality data (1999–2024) for individuals aged ≥65 years. Lung cancer and tobacco use were identified using ICD-10 codes C34 and F17. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Temporal trends were assessed using Joinpoint regression to estimate annual percent changes with 95% confidence intervals, and future mortality was projected using an optimized ARIMA model. Results: From 1999–2024, 1,013,170 lung cancer deaths occurred among tobacco users. AAMRs were highest in Kentucky (171.2) and lowest in California (5.3). Overall AAMRs increased from 11.4 in 1999 to 80.5 in 2024, with projected declines from 77.42 in 2025 to 46.62 in 2035 (AAPC 4.81; 95% CI 3.62–6.02; p<0.001). Mortality was consistently higher in males than females. In 2024, AAMRs were highest among non-Hispanic Whites and in the Midwest, followed by the South. Nonmetropolitan areas had higher AAMRs than metropolitan regions. Conclusions: Lung cancer mortality among tobacco users increased disproportionately among males, non-Hispanic White populations, and rural residents, with the highest burden in the Midwest and South. These findings underscore the need for targeted tobacco-related cancer prevention and improved access to care. Characteristic Number of Deaths (N) Age-Adjusted Mortality Rate (per 100,000):1999 Age-Adjusted Mortality Rate (per 100,000):2024 Average Annual Percent Change (AAPC) (1999–2024) with 95% CI Overall 1,013,170 11.4 80.5 8.72 (6.67 to 10.81) Sex Female 440,665 8.5 65.9 9.00 (7.24 to 10.79) Male 572,505 15.7 99.2 8.01 (6.03 to 10.02) Race and Ethnicity White 913,042 11.6 92.6 9.22 (6.97 to 11.51) Black or African American 77,340 11.3 74 8.43 (6.05 to 10.87) Hispanic or Latino 24,179 5.7 24.8 6.72 (4.02 to 9.48) Census Region West 146,261 17.2 49.7 3.81 (1.38 to 6.31) South 366,699 11.9 81.5 7.95 (5.81 to 10.14) Northeast 197,266 6 73 11.74 (7.74 to 15.88) Midwest 302,944 10.6 118.2 10.72 (7.89 to 13.61) Urbanization (1999–2020) Age-Adjusted Mortality Rate (per 100,000): 1999 Age-Adjusted Mortality Rate (per 100,000):2020 Metropolitan 632,106 10.8 84.8 11.11 (8.66 to 13.60) Non-metropolitan 190,179 13.8 132.2 11.85 (9.13 to 14.65) Age Group Crude Mortality Rates per 100,000:1999 Crude Mortality Rates per 100,000:2024 65–74 years 478,274 11.5 63 7.37 (5.55 to 9.23) 75–84 years 408,955 12.4 101.8 9.20 (7.13 to 11.31) 85+ years 125,941 8 93.8 11.38 (9.04 to 13.76)