Trends and disparities in lung cancer mortality among older adults with chronic lower respiratory diseases: A nationwide analysis of US data from 1999 to 2020.

e22547 Background: Lung cancer is a leading cause of mortality among older adults with a history of chronic lower respiratory diseases (CLRD). Examining trends and disparities in lung cancer mortality within this population is crucial for informing interventions aimed at improving survival outcomes and quality of life for these patients. Methods: We analyzed data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database (1999–2020) to assess lung cancer mortality in adults ≥65 with CLRD. Identified UCD ICD-10 codes for lung cancer were: C33, C34, C39.9, C78.0, C78.3, D02.1-D02.4, D14.2-D14.4. ICD-10 codes for CLRD (J40-47) were added as contributing cause. Age-Adjusted Mortality Rates (AAMRs) were calculated per 100,000 and stratified for age, sex, race, and region. Joinpoint Regression (Version 5.1.0, National Cancer Institute) assessed the temporal trends as annual percentage changes (APCs). Results: Nationwide analysis between 1999-2020 shows the AAMRs had a general decline, starting with 50.4 in 1999 and ending with 38.5 in 2020, with a mean APC of -1.44. Males had a higher mean AAMR (58.7) than females (35.6), but saw a greater fall in mortality rates (APC male: -2.25, APC female: -0.75). White individuals had the greatest mean AAMR (50.2). Geographically, Midwestern US had the highest mean AAMR (52.5). Urban-rural AAMR differences were noted as well (Urban: 42.3, Rural: 54.9). Conclusions: Our study reveals a declining trend in lung cancer mortality among elderly CLRD patients, though gender and ethnic disparities persist. Rural areas, particularly in the Midwest, remain at higher risk, highlighting the need for targeted healthcare interventions to improve outcomes. Lung cancer mortality trends in U.S. older adults with CLRD, 1999–2020. Variable AAMR(95% CI) APC(95% CI) Overall 45.2 (45, 45.3) 1999-2007: -0.20* (-0.72, 0.54) 2007-2020: -2.05* (-2.34, -1.83) Women 35.6 (35.4, 35.7) 1999-2007: 1.12* (0.64, 1.76) 2007-2020: -1.59* (-1.84, -1.36) Men 58.7 (58.4, 58.9) 1999-2006: -1.36 (-2.00, 0.48) 2006-2020: -2.59* (-3.13, -2.37) White 50.2 (50, 50.3) 1999-2006: 0.39 (-0.08, 1.04) 2006-2020: -1.70* (-1.89, -1.53) Black/African American 35 (34.6, 35.5) 1999-2020: -1.32* (-1.58, -1.04) American Indian/Alaska Native 44.1 (42.2, 46.1) 1999-2004: 7.62* (0.84, 35.56) 2004-2020: -1.12* (-4.37, -0.11) Hispanic/Latino 15.5 (15.2, 15.8) 1999-2020: -2.31* (-2.63, -1.95) Asian/Pacific Islander 13.9 (13.5, 14.3) 1999-2007: -1.12* (-4.37, -0.11) 2007-2020: -4.22* (-5.67, -3.45) Rural 58.3 (57.9, 58.6) 1999-2004: 2.01* (0.96, 3.72) 2004-2020: -0.98* ( -1.18, -0.80) Urban 42.3 (42.1, 42.4) 1999-2007: -0.51 (-1.06, 0.43) 2007-2020: -2.25* (-2.65, -1.97)