Trends in ischemic stroke and ischemic heart disease-related mortality among patients with malignancies in the United States: A 25-year CDC-WONDER analysis (1999-2023).

Abstract

11154 Background: Substantial advances in cancer screening, diagnostics, and therapeutic strategies have improved survival and quality of life. Despite these efforts, cancer-related complications continue to contribute significantly to morbidity and mortality. Malignancies induce a prothrombotic state and substantially increase the risk of venous and arterial thromboembolism. As a result, the patients with cancer have a higher incidence of Ischemic stroke (IS) and ischemic heart disease (IHD) compared to the general population. The greatest risk of these thromboembolic diseases is greatest during the first six months of cancer diagnosis, but remains elevated thereafter. In this study, we sought to assess temporal trends and sociodemographic differences in ischemic stroke and ischemic heart disease related mortality among patients with neoplasms. Methods: We analyzed deidentified CDC WONDER death certificate data to assess malignant neoplasm, (ICD = C00-C97) and ischemic heart disease (ICD = I20-I25) and ischemic stroke (ICD = I63) related mortality in patients of all ages. Age-adjusted mortality rates (AAMR) per 100,000 persons and average annual percent change (AAPC) were calculated and stratified by year, gender, state, urban-rural status, census region, place of death (POD), and age group. Results: From 1999 to 2023, 1235844 deaths were attributed to Ischemic stroke and ischemic heart disease-related deaths in cancer patients. Overall, AAMR decreased from 19.7 in 1999 to 12.9 in 2023 (APC -1.74*, 95% CI: -1.88 to -1.63). Males had higher mortality rates than females throughout the period (23.26 vs 8.88, respectively). Racial analysis showed that non-Hispanic whites had the highest mortality (AAMR: 15.064), followed by Blacks or African Americans (AAMR: 14.24); in contrast, Asians or pacific islanders had the lowest mortality (AAMR: 7.48, data available till 2020). The Midwest region had the highest mortality of all census regions (AAMR: 15.92). Lastly, non-metropolitan areas had higher mortality rates than metropolitan areas (AAMR of 15.75 vs 14.04, respectively). Conclusions: Overall mortality rates in cancer patients with co-morbid ischemic stroke and ischemic heart diseases declined from 1999 to 2023. However, higher mortality rates were observed among men, non-Hispanic Whites, residents of the Midwest, and those living in non-metropolitan areas of the U.S., underscoring the need for targeted public health efforts, and equitable access to cardio-oncology preventive care in these high-risk groups.