Trends and disparities in sepsis-related mortality among patients with lung cancer: A 25-year nationwide analysis.

Abstract

e20682 Background: Lung cancer patients face heightened sepsis susceptibility due to disease-related immune dysfunction and treatment-induced myelosuppression. Despite advances in sepsis management, population trends and disparities in sepsis-related mortality among this population remain poorly characterized. Methods: We conducted a retrospective analysis using the CDC WONDER database (1999-2023) for adults aged ≥25 years where both sepsis (ICD-10: A40-A41) and malignant neoplasm of lung (C34) were listed among the causes of death. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Temporal trends were analyzed using Joinpoint regression to determine annual percentage change (APC) and average annual percentage change (AAPC). Results were stratified by sex, age group (25-44, 45-64, ≥65 years), race/ethnicity, urbanization status, census region, and state. Results: From 1999-2023, 104,034 sepsis-related deaths occurred among lung cancer patients. AAMR increased significantly from 1.61 (95% CI: 1.55-1.66) to 2.05 (95% CI: 2.00-2.10), with an overall AAPC of 1.15 (95% CI: 0.20-2.11; p = 0.018). Joinpoint analysis identified significant increases from 1999-2013 (APC: 0.96; 95% CI: 0.56-1.36), followed by attenuation of trends and a non-significant plateau from 2016-2023 (APC: 0.42; 95% CI: -0.51-1.36). Although males had higher AAMR than females (2.48 vs 1.70 in 2023), females demonstrated significantly steeper temporal increases (AAPC: 1.93; 95% CI: 1.73-2.13 vs 0.44; 95% CI: -0.23-1.11). Adults ≥65 years showed significant increases (AAPC: 1.46; 95% CI: 1.31-1.62; p < 0.001). Black or African American individuals had the highest AAMR (2.69 in 2023), followed by Whites (2.18), Asian/Pacific Islanders (1.54), and Hispanics (1.06). Whites exhibited the fastest increase (AAPC: 1.52; 95% CI: 0.75-2.28). Non-metropolitan areas showed significantly higher AAPC (2.40; 95% CI: 1.41-3.41) versus metropolitan areas (0.95; 95% CI: 0.74-1.16), indicating widening rural-urban disparities. Regionally, the South had the highest AAMR (2.38) while the Midwest exhibited the fastest increase (AAPC: 1.78; 95% CI: 1.54-2.02). State-level AAMR ranged from Kentucky (3.08) and West Virginia (3.04) to Utah (0.66) and Wyoming (0.88). The majority of deaths (87.0%) occurred in inpatient medical facilities. Conclusions: This 25-year nationwide analysis reveals a significant rise in sepsis-related mortality among lung cancer patients with pronounced demographic and geographic disparities. Females, rural residents, and populations in Southern and Midwestern states represent vulnerable groups requiring targeted sepsis prevention and early intervention strategies.