Trends and disparities in cerebrovascular disease–related mortality in older adults with colorectal cancer: A nationwide retrospective analysis.

Abstract

e22561 Background: Older cancer patients, particularly those with colorectal cancer (CRC), are at increased risk for incidence and complications of cerebrovascular diseases due to shared risk factors and treatment-related adverse effects. Despite being a leading cause of death worldwide, the burden of cerebrovascular diseases mortality in colorectal cancer patients and mortality trends for cerebrovascular diseases-related deaths in older colorectal cancer patients in the United States (US) remain unexplored. Methods: We analyzed CDC WONDER data (1999–2020) to assess cerebrovascular diseases related deaths among older adults (≥65 years) with CRC in the US. Cases were identified using ICD-10 codes I65-I69 for cerebrovascular diseases as the “underlying” cause and C18.0-C18.3 for CRC as the “contributing” cause. Age-adjusted mortality rates (AAMRs) were calculated by sex, age, ethnoracial groups, and geographical regions. Trends were evaluated using Joinpoint Regression to calculate the average annual percentage change (AAPC) with significance set at ≤0.05. Results: From 1999 to 2020, there were 10,185 cerebrovascular diseases-related deaths among older adults with CRC, showing a significant overall decline (AAPC: -6.01; 95% CI: -6.61 to -5.50). Older men had higher AAMRs compared to older women (1.31 vs. 0.99 per 100,000), with both groups following significant declines (Table). Based on ethnoracial stratification, the non-Hispanic (NH) Black population had a higher overall AAMR (1.21) compared to the NH White population (1.17), with a significant decline in both groups (Table). Non-metropolitan areas had a higher overall AAMR (1.33) compared to metropolitan areas (1.07), with both showing significant declines (Table). Among census regions, the Midwest had the highest mortality burden (AAMR: 1.27), followed by the West (1.18), Northeast (1.07), and South (0.98). The states with the highest AAMRs were North Dakota (2.29) and Vermont (1.84), while Louisiana (0.53) and Arizona (0.50) had the lowest. Conclusions: Cerebrovascular disease-related mortality among older adults with CRC has significantly declined over the past two decades, but disparities persisted, with higher burdens in older men, NH Black populations, non-metropolitan areas, and the Midwest region. Future research should investigate the factors contributing to these disparities and explore targeted interventions to reduce cerebrovascular disease-related mortality in high-risk CRC populations. Variable Duration AAPC Lower 95% CI Upper 95% CI p-value Overall 1999-2020 -6.01 -6.61 -5.50 < 0.01 Female 1999-2020 -5.72 -6.63 -5.11 < 0.01 Male 1999-2020 -6.32 -7.07 -5.65 < 0.01 Black or African American 1999-2020 -6.58 -7.80 -5.52 < 0.01 White 1999-2020 -5.73 -6.33 -5.23 < 0.01 Metropolitan 1999-2020 -6.22 -6.93 -5.66 < 0.01 Non-Metropolitan 1999-2020 -4.80 -5.28 -4.27 < 0.01