Mortality trends of lower respiratory tract neoplasms among older adults with history of tobacco use in the United States, 1999-2020.

e22548 Background: Lower respiratory tract neoplasms (LRTN) are a leading cause of death among the elderly in the U.S. Given the established link between tobacco smoking and increased risk of developing these cancers, it is important to examine trends and disparities in LRTN mortality among individuals with a history of tobacco use. This analysis is key to developing effective screening and targeted intervention strategies. Methods: Data on LRTN mortality among individuals aged ≥55 years with documented history of smoking were retrieved from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database (1999-2020) and analyzed via Joinpoint Regression (Version 5.1.0, National Cancer Institute) to identify temporal trends and calculate Annual Percentage Changes (APCs). The selected MCD ICD-10 codes for LRTN included C33, C34, C78.0, D02.1, D02.2, D14.2, and D14.3. For tobacco use, the ICD-10 code F17 was used. Age-Adjusted Mortality Rates (AAMRs) per 100,000 people were computed and stratified by sex, age bracket, race, and geographic region. Due to data constraints, we combined all lung cancer diagnoses without stratifying by subtype. Results: Between 1999 and 2020, 1,003,583 relevant deaths were recorded. The AAMRs surged dramatically from 8.3 in 1999 to 62.3 in 2005 (APC: 44.39; 95% CI: 33.09 to 68.60), then increased more gradually to 83.9 in 2012 (APC: 3.97; 95% CI: 0.92 to 34.73), before declining to 62.8 by 2020 (APC: -3.37; 95% CI: -12.27 to -0.60). Men consistently exhibited higher AAMRs than women, climbing from 11.3 vs 6.1 in 1999 to 78.8 vs 49.9 in 2020. NH White adults had the highest mean AAMR (68.8), followed by NH American Indian/Alaska Native (64.6), NH Black (56.0), Hispanic (20.2), and NH Asian/Pacific Islander (16.7). Regionally, the Midwest reported the highest AAMR (83.3), followed by the Northeast (63.2), the South (60.9), and the West (41.0). Urban counties had a lower mean AAMR (58.0) than rural counties (81.1). States in the top 90 th -percentile – Oregon (124.4), Vermont (121.7), North Dakota (121.6), Montana (111.4), Wisconsin (109.2), and South Dakota (108.3) – reported five times higher AAMRs than states in the bottom 10 th -percentile. Conclusions: Our study identifies significant disparities in mortality from LRTN among tobacco smokers, with older adults, men, rural residents, and individuals in the Midwest facing a disproportionate burden. These findings highlight the critical need for targeted interventions and tailored public health strategies to mitigate these disparities in vulnerable populations.