Trends in mortality due to lung cancer and infectious respiratory diseases in US from 1999 to 2020: A CDC WONDER analysis.

e20117 Background: Respiratory illnesses, especially infections and lung cancer, are among the deadliest health issues worldwide. Research suggests that lung infections not only occur alongside cancer but may also contribute to its development by weakening the immune system and causing chronic inflammation. These risks vary depending on geography, socioeconomic factors, and access to care, highlighting the need for targeted and equitable public health strategies. Methods: A retrospective analysis was conducted using CDC WONDER data from 1999–2020. Deaths were included if both lung cancer (ICD-10: C34) and infectious respiratory diseases (ICD-10: J09–J18) were listed. Adults aged 25–80 years were analyzed by age, sex, race/ethnicity, region, urbanization and place of death. Age-adjusted mortality rates (AAMRs) per 100,000 population with 95% confidence intervals (CIs) were calculated. Joinpoint regression was used to analyze trends and compute annual (APC) and average annual percent changes (AAPC). Results: From 1999 to 2020, a total of 194,541 adult deaths were identified, corresponding to an overall AAMR of 4.04 per 100,000. Over the study period, mortality demonstrated a sustained decline, with AAMR decreasing from 5.90 in 1999 to 3.16 in 2020, and the most pronounced reduction observed between 2006 and 2009. The majority of deaths occurred in hospital settings (75.3%), followed by home (9.4%) and nursing home (8.7%) settings. Mortality burden was higher among men, who accounted for 118,480 deaths and had a significantly higher AAMR (5.65) compared with women (2.82). Racial and ethnic disparities were observed as Non-Hispanic (NH) Black individuals exhibited the highest AAMR (4.65), followed by NH White (4.01), NH Asian or Pacific Islander (3.16), and NH American Indian or Alaska Native populations (3.03), while Hispanic individuals had the lowest mortality rate (2.01). Although mortality decreased across all racial and ethnic groups, the rate of decline slowed or plateaued after 2009. West Virginia and Kentucky demonstrated the highest state-level AAMRs, whereas Utah and Colorado had the lowest. Regionally, mortality was highest in the South (AAMR: 4.31), followed by the Midwest (4.10) and Northeast (3.90), with the West exhibiting the lowest mortality (3.60). Additionally, nonmetropolitan areas experienced consistently higher mortality rates (12.63) than metropolitan areas (10.64) and showed slower improvements over time. Conclusions: Lung cancer mortality in the U.S. steadily declined from 1999 to 2020, but not all groups benefited equally. Men, NH Black individuals, rural residents, and those in South region experienced higher death rates and slower improvement, pointing to persistent health inequities.