Trends and disparities in cerebrovascular disease-related mortality involving colorectal cancer among older US adults: A nationwide retrospective analysis.
Abstract
Background
Older adults with colorectal cancer (CRC) are at higher risk for cerebrovascular diseases (CeVD) due to shared risk factors and treatment effects. Despite CeVD being a leading global cause of death, its mortality burden in older CRC patients in the US remains underexplored.
Methods
We analyzed CDC WONDER multiple-cause-of-death records from 1999 through 2020 for US decedents aged ≥65 years. CeVD (ICD-10 I60-I69) was the underlying cause of death and CRC (C18-C20) was a multiple or contributing cause. We calculated age-adjusted mortality rates (AAMRs) overall and by sex, race and ethnicity, region, and urbanization; age-specific analyses used crude mortality rates. Joinpoint regression estimated annual percent changes (APCs) and average annual percent changes (AAPCs).
Results
We identified 10,185 CeVD-related deaths involving CRC. The AAMR declined from 2.06 per 100,000 in 1999 to 0.67 in 2020 (AAPC, -5.95%; 95% CI, -6.52% to -5.46%; P < 0.000001). Men had a higher AAMR than women (1.31 vs 0.99); mortality declined in both groups (AAPC, -6.33% and -5.67%, respectively; both P < 0.000001). AAMRs were 1.21 in non-Hispanic Black and 1.17 in non-Hispanic White individuals (AAPC, -6.59% and -5.75%; both P < 0.000001). Regional AAMRs were highest in the Midwest (1.27), followed by the West (1.18), Northeast (1.07), and South (0.98); corresponding AAPCs were -6.35%, -5.52%, -6.68%, and -5.53% (all P < 0.000001). Non-metropolitan areas had a higher AAMR than metropolitan areas (1.33 vs 1.07; AAPC, -4.80% vs -6.25%; both P < 0.000001). Adults aged ≥85 years had the highest crude rate (4.21); AAPCs for ages 65-74, 75-84, and ≥85 years were -5.70%, -7.05%, and -5.65%, respectively (all P < 0.000001).
Conclusions
CeVD-related mortality involving CRC among US adults aged ≥65 years declined from 1999 to 2020, although higher population-level rates persisted among men, non-Hispanic Black individuals, non-metropolitan residents, and residents of the Midwest.