National Trends in Pancreatic Cancer-Related Mortality: A Population-Based Analysis of Rural–Urban Disparities and the Distribution of Place of Death

A 25 year nationwide analysis of mortality trends from cerebrovascular diseases in patients with lung cancer (1999–2023)

Introduction: The two leading causes of death worldwide are lung cancer and cerebrovascular disease (CVD). Due to complications related to the disease and therapy, patients with lung cancer are much more likely to have a stroke, particularly within 2 years after diagnosis. Results are still poor despite medical advancements, underscoring the necessity of comprehensive prevention and care. Methods: ICD-10 codes for lung cancer (C34) and cerebrovascular illness (I60–I69) were used to evaluate mortality data from CDC WONDER (1999–2023). When both illnesses were listed on death certificates, deaths were counted. Sex, race/ethnicity, area, and urban/rural status were used to compute age adjusted mortality rates (AAMRs). Joinpoint regression was used to evaluate trends, and P < 0.05 was considered significant. Results: Overall AAMR for CVD and lung cancer decreased from 2.19 to 1.44 per 100 000 (APC: −2.9; P < 0.0001) between 1999 and 2015, subsequently increased to 1.71 in 2023 (APC: +2.8; P < 0.0001). From 3.08 in 1999 to 1.98 in 2023, men’s rates were continuously higher than women’s (1.59 to 1.49). The AAMR was highest among NH Black people (it peaked at 2.32 in 2023), followed by NH Whites (1.68) and Hispanics (0.69). Rural areas had higher AAMR than Urban areas. Alaska (2.57), Vermont (2.46), and Mississippi (2.46) had the highest state level burdens, while Utah (0.64) and New Mexico (0.86) had the lowest, while the South and Midwest region saw the sharpest recent rises. Conclusion: Lung cancer mortality from CVD increased until 2023 after decreasing until 2015. The U.S. South, rural areas, Black adults, and men had the biggest burden. To lower stroke mortality in patients with lung cancer, targeted interventions are required, with a focus on addressing racial and rural disparities in care, prevention, and access.

Temporal Trends and Disparities in Liver Cell Carcinoma and Hepatic Failure Mortality in the United States: A 24-Year Analysis from CDC WONDER, 1999-2023

Background: Liver cell carcinoma (LCC) and hepatic failure (HF) are significant contributors to liver-related mortality in the United States. This study assessed LCC- and HF-related mortality trends (1999–2023) using CDC WONDER data, stratified by demographics and geography. Methods: Deaths among U.S. adults aged ≥25 years with LCC (ICD-10: C22.0) or HF (ICD-10: K72.9) as underlying or contributing causes were analyzed. AAMRs per 1,000,000 were calculated by direct standardization to the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs) in AAMRs, stratified by sex (1999–2023) and race/ethnicity, urban-rural status, census region, and state (1999–2020). Results: From 1999–2023, 22,963 adult deaths were recorded (77.6% men). Overall AAMR declined from 1999–2007 (APC: −2.4), was stable through 2017 (APC: +0.2), then fell through 2023 (APC: −3.5). Male AAMR followed a non-linear trajectory (APC: −2.1, 1999–2010; +0.7, 2010–2017; −4.4, 2017–2023); female AAMR was stable post-2006 (APC: −0.1). NH Asian or Pacific Islanders showed the steepest decline (APC: −6.7); Hispanics increased post-2010 (APC: +0.6). Metropolitan AAMR declined overall; non-metropolitan AAMR increased (APC: +1.3). The West had the highest regional AAMR (5.6 per 1,000,000); Hawaii the highest state-level AAMR (10.3 per 1,000,000). Conclusion:  LCC- and HF-related mortality declined overall, with descriptive subgroup variation by sex, race/ethnicity, urbanization, and geography. Targeted screening, hepatitis management, and equitable healthcare access are needed to address these patterns.

Trends and disparities in colorectal cancer mortality among adults with diabetes mellitus in the United States: A retrospective analysis, 1999–2025 and projections to 2040

Trends and projections in cause-specific mortality among patients with colorectal cancer in the United States, 1999–2040

Background As CRC survival improves, the shifting contributions of metastatic and non-cancer causes to mortality remain poorly characterized, with implications for survivorship care and public health policy. This study aimed to examine temporal trends in CRC mortality with selected contributing conditions from 1999 to 2023 and project rates through 2040 across demographic and geographic subgroups in the United States. Methods This population-based cohort study utilized mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. The study included 1,323,609 US residents aged 25 years or older who died from 1999 through 2023 with colorectal cancer listed as the underlying cause of death. We analyzed selected contributing conditions recorded in the multiple cause-of-death field, including heart failure, ischemic heart disease, liver metastasis, lung metastasis, pulmonary embolism, and sepsis. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Future mortality rates were projected to 2040 using autoregressive integrated moving average (ARIMA) modeling. Results Overall CRC AAMR declined from 32.06 in 1999 to 19.57 in 2023 (AAPC,−2.08%). Recent significant increases were observed in liver metastasis mortality from 2016 to 2023 (APC: 2.89%), lung metastasis mortality from 2017 to 2023 (APC: 2.08%), pulmonary embolism mortality from 2012 to 2023 (APC: 3.59%), and heart failure mortality from 2013 to 2023 (APC: 3.16%). These trends were most pronounced among adults aged 35–64 years, non-Hispanic Black individuals, and residents of the Southern US. Model-based projections indicate that overall lung metastasis mortality will continue to increase through 2040, whereas liver metastasis mortality will peak in 2028 and subsequently decline. In pre-pandemic sensitivity analyses, the post-2012 increase in PE mortality persisted, whereas recent increases in IHD, HF, liver metastasis, and sepsis mortality were attenuated or no longer statistically significant. Conclusions Despite declining overall CRC mortality, recent increases were observed in several metastatic and noncancer contributing conditions. However, pre-pandemic sensitivity analyses suggested that some late-period changes may have been amplified during the COVID-19 era, whereas the increase in PE mortality clearly preceded the pandemic.

Mortality trends of gallbladder cancer in middle-aged and older adults in the United States: a CDC WONDER analysis from 1999 to 2023

Background Gallbladder cancer (GBC) is a rare but highly lethal malignancy, often diagnosed at advanced stages due to the absence of early symptoms. Although its incidence is relatively low in the United States, marked demographic and geographic disparities persist, and long-term national mortality trends remain insufficiently characterized. Methods We analyzed gallbladder cancer·–related deaths (ICD-10 code C23) among U.S. adults aged 45 years and older from 1999 to 2023 using the CDC WONDER database. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. For age-stratified analyses, crude mortality rates were used instead of AAMRs, as age adjustment within predefined strata is inappropriate. Temporal trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) overall and by sex, age group, race and ethnicity, census region, and urbanization level. Results During the study period, 50,938 gallbladder cancer–related deaths were recorded. Overall, the AAMR declined from 2.10 per 100,000 in 1999 to 1.39 per 100,000 in 2023, with significant decreases across multiple time intervals (AAPC = -1.76, 95% CI: -2.16 to -1.36, P ≤ 0.05). Mortality increased markedly with age, and individuals aged 85 years and older consistently exhibited the highest rates. Females had higher mortality rates than males throughout the study period (1.72 vs. 1.01 per 100,000 in 2023), although declining trends were observed in both sexes. Significant reductions in mortality were observed among Hispanic, non-Hispanic White, and non-Hispanic Other populations; however, no significant decline was observed among non-Hispanic Black individuals (AAPC = -0.14, 95% CI: -0.60 to 0.33, P > 0.05). Regionally, mortality was highest in the Northeast and lowest in the South. Mortality rates were consistently higher in metropolitan than in non-metropolitan areas (1.51 vs. 1.48 per 100,000 in 2020). Conclusion Although gallbladder cancer mortality among middle-aged and older adults in the United States has declined over the past two decades, this improvement has been uneven. Persistent disparities by age, sex, race and ethnicity, region, and urbanization remain, particularly among non-Hispanic Black populations. These findings underscore the need for targeted and equitable public health strategies to further reduce gallbladder cancer mortality.

Trends and Disparities in Mortality Involving Pancreatic Cancer and Pulmonary Embolism in the United States, 1999–2024: A CDC WONDER Analysis

Background: U.S. mortality trends involving pancreatic cancer and pulmonary embolism (PE) and whether PE is becoming increasingly represented among pancreatic cancer deaths remain incompletely characterized. Methods: We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥ 25 years from 1999 through 2024. Deaths were included in the primary analysis when pancreatic cancer and PE were both recorded as underlying or contributing causes. Age-adjusted mortality rates (AAMRs) were evaluated using Joinpoint Regression Program version 6.0.1. Forecasting and additional weighted log-linear and segmented regression analyses were performed in R version 4.5. Additional analyses evaluated race/ethnicity, the proportion of pancreatic cancer underlying-cause deaths with PE recorded, and sensitivity to the COVID-19 years. Results: Overall, 18,243 deaths involved both pancreatic cancer and PE. The AAMR increased from 0.19 per 100,000 in 1999 to 0.55 in 2024. Mortality increased by 2.65% annually during 1999–2016 and by 8.54% annually during 2016–2024, with a significantly steeper post-2016 slope (p < 0.001). Rates were consistently higher among males and non-Hispanic Black individuals. Hispanic or Latino mortality increased significantly during 2011–2024, whereas estimates for Asian or Pacific Islander individuals were too sparse or frequently suppressed to support reliable longitudinal trend analysis. Among deaths with pancreatic cancer as the underlying cause, the proportion with PE recorded increased from 1.00% in 1999 to 2.85% in 2024, with significantly faster growth after 2016 (p < 0.001). Excluding 2020–2021 did not materially alter the post-2016 increase. Conclusions: Mortality involving pancreatic cancer and PE increased substantially in the United States, and PE was recorded in a growing proportion of pancreatic cancer deaths. These death-certificate data identify an increasing population-level burden but cannot establish causality or demonstrate the effectiveness of specific clinical interventions.