Trends in mortality rates for cancer as underlying cause with stroke as contributing cause among US adults: Analysis of CDC WONDER database, 1999 to 2023

Cancer survivors face elevated risks of cerebrovascular complications, yet long-term mortality trends among adults who experience both cancer and stroke remain insufficiently defined. This study examined national temporal patterns in age-adjusted mortality rates (AAMRs) among US deaths with cancer as the underlying cause and stroke listed as a contributing cause from 1999 to 2023. We performed a population-based analysis using US national mortality data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. Deaths were included when cancer (ICD-10: C00-C97) was the underlying cause and stroke (ICD-10: I60-I69) was listed as a contributing cause among individuals aged ≥25 years. AAMRs per 100,000 population were age-standardized to the 2000 US standard population. Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC) and average annual percentage change. Forecasts for 2035 were generated with an autoregressive integrated moving average model. From 1999 to 2023, 314,155 deaths involved both cancer and stroke. The overall AAMR declined from 6.94 to 6.16 per 100,000 (average annual percentage change = -0.51*; 95% confidence interval [CI] = -0.93 to -0.09). Joinpoint regression analysis delineated 3 distinct temporal phases: a significant decline from 1999 to 2009 (APC = -2.99*; 95% CI = -3.48 to -2.49), followed by a continued yet attenuated decline from 2009 to 2016 (APC = -1.30*; 95% CI = -2.41 to -0.18), and a subsequent marked increase from 2016 to 2023 (APC = 3.98*; 95% CI = 3.16-4.80). In 2023, the AAMR reached 6.16 (95% CI = 6.06-6.25). Persistent disparities were observed across sex, race/ethnicity, geographic region, and age groups. Autoregressive integrated moving average forecasts suggest continued growth in mortality counts and AAMRs through 2035. After more than a decade of improvement, mortality associated with cancer and stroke has shown a concerning reversal since 2016, with widening demographic and geographic disparities. These findings underscore the need for further research into integrated oncology and cerebrovascular prevention and care strategies.