Trends and disparities in hypertension mortality among patients with lung cancer: A retrospective CDC-WONDER analysis (1999-2020).

Abstract

e20159 Background: Lung cancer (LC) is the leading cause of cancer deaths in the U.S., with older adults disproportionately affected. Hypertension (HTN) is highly prevalent in this population and may worsen outcomes. National trends in LC mortality among adults with HTN remain poorly described. This study used CDC WONDER data to evaluate temporal trends, demographic disparities, and geographic variation in LC-related mortality among adults ≥55 years with HTN from 1999–2020. Methods: Death certificate data from CDC WONDER database were analyzed for adults ≥55 years with LC as the underlying cause and HTN as a contributing cause (ICD-10: C34.0–C34.9; I10–I15). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression estimated annual percent change (APC) with 95% confidence intervals. Analyses were stratified by age, sex, race/ethnicity, Hispanic origin, urbanization, and state. Results: Between 1999 and 2020, 217,037 deaths occurred among U.S. adults aged ≥55 years with LC and HTN listed as underlying or contributing causes. Overall age-adjusted mortality rates (AAMRs) increased from 7.6 (95% CI: 7.4–7.8) per 100,000 in 1999 to 16.5 (95% CI: 16.3–16.8) in 2020. Mortality rose significantly from 1999–2001 (APC 18.03%, 95% CI: 8.64–27.34; p < 0.001), declined modestly between 2007–2018 (APC −0.63%, 95% CI: −2.92 to −0.14; p = 0.02), and increased again from 2018–2020 (APC 8.65%, 95% CI: 2.62–11.76; p < 0.001). Across age strata, all groups demonstrated early increases followed by mid-period declines and significant pandemic-associated peaks (p < 0.01), with the highest AAMRs observed in adults aged ≥85 years. Men consistently had higher AAMRs than women (17.0 vs 11.0 per 100,000; p < 0.001), though both sexes showed significant increases after 2018 (p < 0.001). Racial disparities were evident, with the highest AAMRs among Non-Hispanic (NH) Black/African American adults (20.27 per 100,000), followed by Hispanic Latino (14.03) and NH White populations (13.07). Non-metropolitan areas exhibited higher AAMRs than metropolitan areas (16.17 vs 13.16 per 100,000). States with age-adjusted mortality rates at or above the 90th percentile (≥19.2 per 100,000) included Oklahoma (27.0), Mississippi (26.2), West Virginia (21.6), Ohio (21.2), Nebraska (19.3) and Kentucky (19.2). Conclusions: LC mortality among adults with HTN rose substantially from 1999–2020, disproportionately affecting older adults, males, NH Black/African Americans, and rural populations. These findings highlight the need for targeted interventions, including risk factor management, early screening, and improved access to care in high-risk groups.