Trends in cardiovascular mortality among lung cancer patients in the United States: a retrospective study from 1999 to 2023

BACKGROUND: Although cardiovascular disease (CVD) frequently co-occurs with lung cancer and adversely affects prognosis, the temporal patterns of CVD mortality in this patient group remain inadequately explored. We aimed to clarify trends and disparities in CVD mortality among United States (US) adults with lung cancer. METHODS: Utilizing the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) spanning from 1999 to 2023 for adults aged 35 years and older, we calculated age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals, with the AAMRs standardized to the 2000 US population. The annual percent change (APC) and average annual percent change (AAPC) were estimated using joinpoint regression analysis. In CDC WONDER, the National Center for Health Statistics assigns the underlying cause of death using standardized World Health Organization rules. Thus, we defined CVD as the underlying cause of death and lung cancer as a contributing cause based on the database's coding framework rather than investigator judgment. RESULTS: Among 93,859 CVD deaths in lung cancer patients, mortality declined significantly from 1999 to 2015 (APC: - 4.70), but increased in females from 2015 to 2023 (APC: 1.73), while remaining stable in males (APC: 0.44). Males experienced a more pronounced reduction in AAMRs, decreasing from 5.39 in 1999 to 2.24 in 2023, but consistently had higher CVD mortality rates than females. During most of the study period, Non-Hispanic African American or Black (NH Black) individuals experienced the highest AAMRs, followed by NH Whites. Long-term decline in CVD mortality reversed significantly among individuals aged ≥ 85 years since 2017. Significant differences in AAPC relative to the general population were identified among the Northeast, NH Black, NH White, males, and across all age groups except for the 75-84 cohort. CONCLUSIONS: Although CVD mortality in the US declined from 1999 to 2023, this trend has stalled or reversed among adults with lung cancer since 2015. Ongoing disparities by sex, race, age, region, and state emphasize the urgent need for targeted interventions for these vulnerable groups.