Trends and disparities in mortality from malignant neoplasms and cardiac arrest in the United States, 1999–2023.

Abstract

e23365 Background: Malignant neoplasms (MN) significantly heighten mortality risk when they co-occur with cardiac arrest (CA), reflecting tumor burden and cardiovascular compromise. This study aims to analyze and interpret annual trends and disparities in mortality to evaluate public health initiatives. 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 100,000 for MN (ICD-10 Codes: C00-C97) and CA (ICD-10 Codes: I46.0; I46.1; 146.9), 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: A total of 1,497,522 deaths (females: 700,232; males: 797,290) were reported among malignant neoplasms and cardiac arrest patients, mostly in medical facility inpatient settings. The overall AAMR has decreased from 37.12 in 1999 to 21.17 in 2023 (AAPC: -2.25; 95% CI: -2.55 to -1.94; p < 0.001), with the most significant declines observed between 1999–2004 (APC: -3.49) and 2004–2019 (APC: -2.38). Adults aged ≥65 years experienced the highest CMR (104.23), with an annual decline in mortality by -2.50% (p < 0.001). Men were analyzed to have higher AAMR (34.36 vs 22.69), but a more pronounced decline in mortality than women (AAPC: -2.47 vs -2.06). Racial disparities show that the highest AAMR was observed among non-Hispanic (NH) Blacks (40.43), while the lowest was noted among NH Americans (20.88). Geographic disparities were evident, with the Northeastern region having the highest AAMR (44.69) and the Midwest having the least (12.64). Metropolitan areas showed a higher AAMR (29.26 vs 23.19) and a steeper decline in mortality than non-metropolitan areas (AAPC: -2.80 vs -1.85). At the state level, New York (88.12) and California (55.93) ranked highest, placing in the top 90th percentile during 1999–2020 and 2021–2023, respectively. Conclusions: Despite a significant decline in mortality related to malignant neoplasms and cardiac arrest over the past two decades, disparities persist, especially among older men, NH Blacks, and those living in metropolitan areas and the Northeastern region. Targeted interventions and equitable access to healthcare are needed to reduce mortality and address persistent health inequities among vulnerable populations. Average annual percent change (AAPC) of age-adjusted mortality rates for Malignant Neoplasms and Cardiac-arrest in the United States, 1999 to 2023. Variable Deaths AAPC (95%CI) Overall 1,497,522 -2.25 (-2.55 to -1.94) Male 797,290 -2.47 (-2.77 to -2.16) Female 700,232 -2.06 (-2.34 to -1.79) Non-metropolitan areas 191,983 -1.85 (-2.03 to -1.66) Metropolitan areas 1,126,984 -2.80 (-3.01 to -2.57)