Pronounced gender-based and regional disparities in lung cancer mortality in the US: Insights from five decades of nationwide mortality data.

Abstract

8079 Background: Lung cancer remains the leading cause of cancer-related mortality in the United States, necessitating an understanding of long-term mortality trends to evaluate public health interventions and identify disparities. This study examines lung cancer mortality trends from 1968 to 2016 using data from the CDC WONDER database, stratified by demographic and regional characteristics. Methods: The analysis included deaths attributed to lung cancer, identified using International Classification of Disease (ICD) codes across three periods: ICD-8 (1968–1978), ICD-9 (1979–1998), and ICD-10 (1999–2016). Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were assessed with Joinpoint regression analysis to estimate annual percentage changes (APC) and average annual percentage changes (AAPC) with 95% confidence intervals (CIs). Data were stratified by gender, race, and U.S. Census regions. Results: Between 1968 and 2016, there were 6,289,300 deaths attributed to lung cancer in the U.S. The overall AAMR rose from 53.53 to 59.28, with an AAPC of 0.22 (95% CI: 0.19 to 0.25). Notable trends included a sharp rise from 1968 to 1980 (APC: 3.02; 95% CI: 2.88 to 3.18), a slowdown from 1980 to 1991 (APC: 1.72; 95% CI: 1.60 to 1.83), a decline from 1991 to 2004 (APC: -0.84; 95% CI: -0.92 to -0.75), a steeper drop from 2004 to 2012 (APC: -2.17; 95% CI: -2.36 to -1.96), and an acceleration from 2012 to 2016 (APC: -3.83; 95% CI: -4.40 to -3.40). Of the total, 37.1% of deaths were females (2,333,863) and 62.9% were males (3,955,437). The male AAMR decreased from 97.85 to 72.2 (AAPC: -0.65; 95% CI: -0.69 to -0.62), while the female AAMR rose from 17.96 to 49.24 (AAPC: 2.14; 95% CI: 2.10 to 2.19). Racially, 656,875 deaths (10.4%) involved Black or African Americans, who had higher AAMRs than the 5,534,744 deaths (88%) among Whites. Whites saw a more marked increase in AAMR (AAPC: 0.29; 95% CI: 0.27 to 0.32) compared to Blacks (AAPC: 0.095; 95% CI: 0.055 to 0.14). Regionally, the South had the highest AAMR at 83.2, while the West, with the lowest at 68.58, was the only region to experience an overall decrease from 52.74 in 1968 to 45.64 in 2016. Conclusions: The decline in overall mortality rates since 2004 underscores the effectiveness of smoking cessation programs and treatment advancements; yet, rising female mortality and high rates in the South call for a reassessment of outreach efforts to ensure public health strategies.