Trends in mortality due to lung cancer in patients with respiratory tract infections in the United States, 1999–2023: A CDC population-based analysis.

Abstract

e20061 Background: Lung cancer remains the leading cause of cancer-related mortality in the United States. Respiratory tract infections (RTIs) are common complications among patients with lung cancer due to immunosuppression, airway obstruction, and treatment-related toxicity, and are associated with worsened clinical outcomes. Despite the clinical relevance of RTIs in lung cancer care, national-level evaluations of long-term mortality trends among lung cancer patients with concurrent RTIs remain limited. This population-based study examines temporal trends, demographic disparities, and geographic variation in lung cancer–related mortality among patients diagnosed with RTIs in the United States from 1999 to 2023. Methods: Mortality data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database for the years 1999–2023. Deaths were identified using ICD-10 codes with lung cancer listed as the underlying cause of death and respiratory tract infection recorded as a contributing condition. Analyses were stratified by calendar year, sex, race and ethnicity, age, place of death, urbanization status, and U.S. census region. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population with corresponding 95% confidence intervals. Temporal trends were evaluated using Joinpoint regression to estimate the average annual percent change (AAPC). Results: Between 1999 and 2023, a total of 222,792 lung cancer–related deaths were identified among patients with RTIs in the United States, with the majority occurring in medical facilities (128,308 deaths). The overall AAMR declined substantially from 3.85 per 100,000 in 1999 to 1.94 per 100,000 in 2023, corresponding to an AAPC of -2.54 (95% CI, -3.63 to -1.45), though a modest increase was observed during 2021–2022. Men experienced a higher average AAMR than women (3.71 vs 1.84), with a steeper decline over time among men (AAPC -3.57 vs -1.56). By race and ethnicity, non-Hispanic Black individuals had the highest AAMR (3.09), while Hispanic individuals had the lowest (1.38). Mortality rates were higher in non-urban areas (AAMR 3.25; AAPC -2.79) compared with urban areas (AAMR 2.51; AAPC -3.23). Regionally, the South exhibited the highest AAMR (2.84), while the West had the lowest (2.38). Conclusions: Lung cancer mortality among patients with RTIs declined significantly in the United States from 1999 to 2023; however, persistent disparities by sex, race and ethnicity, geographic region, and urbanization remain. These findings underscore the need for targeted infection prevention strategies, equitable access to pulmonary and oncologic care, and focused interventions for vulnerable populations, particularly during periods of healthcare system strain.