Temporal trends in cardiovascular and cerebrovascular mortality among U.S. decedents with malignant neoplasms of the bronchus and lung, 1999–2020.

Abstract

e20110 Background: Lung cancer is associated with substantial cancer-specific mortality; however, cardiovascular diseases remain important competing causes of death due to shared risk factors such as tobacco exposure, advanced age, and cardiometabolic comorbidities. Data describing long-term national trends in specific cardiovascular causes of death among individuals with lung cancer are limited. We evaluated temporal trends in mortality due to ischemic heart disease (IHD), hypertensive diseases, heart failure (HF), and cerebrovascular disease (CeVD) among U.S. decedents with malignant neoplasms of the bronchus and lung. Methods: Using a population-based analysis, CDC WONDER , multiple cause of death database from 1999 to 2020, decedents with malignant neoplasms of the bronchus and lung (ICD-10: C34) and ischemic heart disease (I20–I25), hypertensive diseases (I10–I15), heart failure (I50), or cerebrovascular disease (I60–I69) as the underlying cause of death were identified. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were analyzed using the National Cancer Institute Joinpoint Regression Program to estimate annual percent change (APC) and average annual percent change (AAPC). Stratified analyses were performed by sex, age group, race, and geographic region. Results: Ischemic heart disease mortality declined significantly in both females (AAPC −4.1%, p < 0.001) and males (AAPC −4.8%, p < 0.001). Among males, a late joinpoint demonstrated a non-significant increase after 2017 (APC 2.17%, p = 0.12). Heart failure mortality also declined modestly in females (APC −2.1%, p = 0.009) and males (APC −2.74%, p = 0.001). In contrast, hypertensive disease mortality increased significantly in recent years, particularly among males (APC 23.64% from 2018–2020, p < 0.01) and females (APC 7.46% from 2009–2020, p = 0.018). Significant increases were observed in older age groups (65–74 years: APC 7.31%, p = 0.01; 75–84 years: APC 7.02%, p = 0.013) and among Black/African American individuals (APC 31.5% from 2018–2020, p < 0.001). Cerebrovascular disease mortality declined overall in females (AAPC −1.9%, p < 0.001) and males (AAPC −3.3%, p < 0.001), followed by recent increases among males after 2011 (APC 7.5%, p = 0.023) and among Black/African American individuals after 2015 (APC 6.4%, p = 0.046). Across all cardiovascular outcomes, mortality increased with advancing age. Conclusions: Despite declining ischemic heart disease, heart failure, and cerebrovascular mortality, hypertensive disease–related deaths are increasing among individuals with lung cancer, particularly in older adults and Black/African American populations, highlighting the need for early blood pressure control and integrated cardio-oncology care.