Trends in colorectal cancer and iron deficiency anemia–related mortality in the United States: A nationwide retrospective analysis over 24 years.

Abstract

e15648 Background: Iron deficiency anemia (IDA) is the most common extra intestinal symptom in patients with colorectal cancer (CRC). IDA is also linked to a decreased long term overall survival rate and disease-free survival rate in CRC patients. The prevalence of CRC and IDA is increasing in the United States (US). However, population-level data for mortality trends related to CRC and IDA are limited. This study aims to assess these mortality trends among adults in the US, stratified by sex, race, urbanisation, and age group. Methods: We queried the CDC-WONDER database for multiple cause of death data of adults aged ≥25 years. International Classification of Diseases (ICD 10) codes C18, C19, and C20 for CRC and D50.0, D50.1, D50.8, D50.9 for IDA were used to extract mortality data. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 individuals were computed. Joinpoint regression analysis was used to determine the annual percent changes (APCs) with a 95% confidence interval (CI). Average annual percentage changes (AAPCs) were computed as weighted average of APCs. Results: From 1999 to 2022, there were 3,192 deaths related to CRC and IDA among adults aged over 25 years in the US. The AAMR was 0.05 in 1999, increasing to 0.09 in 2020 and 0.10 in 2022. The AAMR showed a decreasing initial trend from 1999 to 2012, with an APC of -3.65, followed by a steep increase through 2022 (APC: 11.67). The AAPC for the entire study period indicated a significant increasing trend (AAPC: 2.74). The AAMR for males (0.06) was greater than that for females (0.05) from 1999 to 2020, but the reverse was true from 2021 to 2022 (AAMR male: 0.093; female: 0.095). Among age groups, individuals aged 75-84 and above 85 both showed significant declines followed by sharp rises in CMR. The South and Midwest regions exhibited a recent significant increase in AAMR, although that for the South was considerably stable since 2018. From 1999 to 2020, rural areas (0.07) exhibited a consistently greater AAMR than urban areas (0.05), despite the majority of deaths (75%) occurring in urban areas. Mortality data stratified by urbanisation was unavailable for 2021 and 2022. Conclusions: This analysis highlights the significant relationship between IDA and CRC mortality, revealing alarming trends of increasing deaths since 2012, particularly among younger adults and underserved populations. While advancements in CRC screening and treatment have improved outcomes, disparities persist, amplified by limited healthcare access, socioeconomic barriers, and the COVID-19 pandemic's disruption of care. Early diagnosis and integrated management of IDA within CRC treatment protocols, alongside targeted public health efforts, are vital to addressing these inequities and improving survival rates, particularly in high-risk groups.