Cerebrovascular mortality in patients with head and neck cancer in the United States, 1999-2023: A population-based analysis.

e18106 Background: Survival gains in head and neck cancer (HNC) have increased the importance of non-cancer mortality in older adults. Cerebrovascular disease is a major competing cause of death due to shared risk factors and treatment-related vascular injury, yet long-term national and subgroup-specific mortality trends remain poorly defined. Therefore, we evaluated national and subgroup-specific cerebrovascular mortality trends in U.S. adults aged ≥55 years with HNC from 1999–2023. Methods: Death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database were examined from 1999 to 2023 for multiple causes of death using multiple causes of death (MCD) MCD-ICD-10 codes for head and neck cancer (C00–C14, C30–C32) and cerebrovascular disease (I60–I69). Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated for older adults (age 55+) and stratified by ten-year age group, sex, race/ethnicity, census region and state. Results: From 1999–2023, 14,255 cerebrovascular-related deaths occurred in older adults with Head and Neck Cancer. Overall mortality declined from 1999–2010 (AAMR dropped from 1.03 to 0.6; APC –4.54%, 95% CI –8.07 to –3.41,p=0.02), plateaued till 2016 (AAMR: 0.61; APC –0.24%, 95 CI -3.99 to 4.84, p = 0.89), and then increased significantly till 2023 (AAMR: 0.87; APC 6.09%, 95% CI 4.06 to 10.82, p=0.006). Among females, AAMR declined from 0.52 in 1999 to 0.26 in 2016 (APC –4.21%, 95%CI -6.3 to -3.0) and then increased to 0.41 by 2023 (APC 9.01%, 95% CI 4.40 to 20.27). For males, AAMR declined from 1.76 in 1999 to 1.0 in 2014 (APC –4.01%, 95%CI -4.98 to 3.24) and then increased to 1.44 by 2023 (APC 5.66%, 95% CI 4.14 to 7.81). In 2023, AAMRs were highest among NH Black individuals (0.97), followed by NH White (0.91) and NH Asian (0.49) populations. Regionally, South had the highest AAMR(0.96) in 2023 followed by the Midwest (0.88), West (0.81) and Northeast (0.7). State-level AAMRs peaked in Oregon (1.89), Minnesota (1.84), and Wisconsin (1.47), with lowest rates in California (0.75) and New York (0.64). Conclusions: After decades of decline, cerebrovascular mortality in Head and Neck Cancer patients has risen markedly since 2016, especially among women and Black individuals. These findings underscore the need for cerebrovascular screening and prevention strategies integrated into survivorship care.