Trends and disparities in lung cancer and atrial fibrillation/flutter–related mortality in the United States, 2000–2023.

Abstract

e23367 Background: Lung cancer remains a leading cause of mortality among U.S. adults, frequently complicated by cardiovascular comorbidities that exacerbate disease severity and limit treatment options. This study aims to analyze and interpret annual mortality trends and disparities among adults in the United States from 2000 to 2023, for various demographic and geographic factors. Methods: The mortality data from the CDC WONDER multiple cause of death files for adults aged ≥25 years were used to analyze age-adjusted and crude mortality rates (AAMRs and CMRs) per 1,000,000 through ICD 10 code: C34 (lung cancer) and ICD 10 code: I48 (atrial fibrillation/flutter), stratified by year, gender, race/ethnicity, place of death and geography. Joinpoint regression was used to estimate average annual percent change (AAPC) and annual percent change (APC) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. Results: From 2000 to 2023, a total of 99,451 deaths were attributed to lung cancer with coexisting atrial fibrillation/flutter, most occurring among medical facility inpatient settings. The overall AAMR increased from 11.87 in 2000 to 25.83 in 2023 (AAPC: 3.38; 95% CI: 2.80 to 3.96), with the most significant increase observed between 2018 and 2021 (APC: 6.90; 95% CI: 2.85 to 11.11). Men had a higher AAMR than women (25.07 vs 12.71). However, the rise in mortality was more pronounced among women than among men (AAPC: 4.15 vs 2.71). Adults aged 65 and above experienced the highest CMR (80.50), though the increase was more rapid among adults aged 45–64 years (AAPC: 5.00 vs 3.14). The highest AAMR was observed among non-Hispanic (NH) Whites (20.32), while the lowest was noted among Hispanics or Latinos (5.74). Geographic disparities were evident, with the Midwest having the highest AAMR (19.34) and the West having the lowest AAMR (17.03). Non-metropolitan areas showed a sharper rise in mortality (AAPC: 4.43 vs 3.07) and a higher AAMR than metropolitan areas (19.47 vs 16.44). At the state level, Vermont and Nebraska ranked highest, falling in the top 90th percentile during 2000–2020 and 2021–2023, respectively. Conclusions: Mortality trends related to lung cancer and atrial fibrillation/flutter have increased over the past two decades, placing a disproportionate burden among men, NH White individuals, and those residing in the Midwest region and non-metropolitan areas. This underscores the need for targeted interventions and delivery of equitable healthcare for the high-risk population. Average annual percent change (AAPC) of age-adjusted mortality rates for Lung Cancer and Atrial Fibrillation/Flutter in the United States, 2000 to 2023. Variable Deaths AAPC (95%CI) Overall 99,451 3.38 (2.80 to 3.96) Male 58,818 2.71 (1.82 to 3.60) Female 40,633 4.15 (3.73 to 4.56) Non-metropolitan areas 16,108 4.43 (4.10 to 4.76) Metropolitan areas 62,053 3.07 (2.92 to 3.22)