National trends and disparities in mortality associated with radiological procedures and radiotherapy (1999–2019)

Radiological procedures and radiotherapy are integral components of modern medical care but may be associated with treatment-related complications and mortality. Contemporary nationwide data evaluating mortality trends associated with radiological procedures and radiotherapy in the United States remain limited. This study evaluated national trends and disparities in mortality associated with radiological procedures and radiotherapy from 1999 to 2019. We conducted an observational study using the CDC WONDER Multiple Cause of Death database from 1999 to 2019. Deaths associated with radiological procedures and radiotherapy were identified using the International Classification of Diseases, Tenth Revision code Y84.2, recorded as either an underlying or contributing cause of death. Yearly crude mortality rates and age-adjusted mortality rates per 100,000 population were calculated. Mortality trends were stratified by sex, age, race/ethnicity, census region, state, and urbanization status. Temporal trends were evaluated using Joinpoint regression analysis with calculation of annual percent change and average annual percent change (AAPC) with 95% confidence intervals (CI). A total of 22,542 deaths associated with radiological procedures and radiotherapy were identified during the study period. The overall age-adjusted mortality rate was 0.33 per 100,000 population (95% confidence interval: 0.33–0.33). Mortality rates declined from 0.50 per 100,000 population in 1999 to 0.24 per 100,000 population in 2019, with an AAPC of -3.62% (95% CI: -4.17 to -3.20, P < 0.000001). Males demonstrated higher mortality rates than females (0.38 versus 0.28 per 100,000 population), although both groups showed significant declines over time ( P < 0.000001 for both). Mortality rates increased progressively with advancing age and were highest among adults aged ≥ 85 years (crude mortality rate 2.94 per 100,000 population). Rural areas demonstrated higher mortality rates than urban areas (0.38 versus 0.32 per 100,000 population). Geographic variations were also observed, with the Midwest demonstrating the highest regional mortality rates. Mortality associated with radiological procedures and radiotherapy in the United States declined between 1999 and 2019. Demographic and geographic disparities were seen, particularly among older adults, males, rural populations, and certain regions. These findings provide national estimates of mortality associated with radiological procedures and radiotherapy and may help inform future studies evaluating procedural safety and healthcare disparities. Not applicable.