Trends in mortality among older diabetic patients with lung cancer in the United States (1999–2023).

Abstract

e20779 Background: Lung cancer is the leading cause of cancer death in the United States. Diabetes is common in older adults and may worsen outcomes via metabolic, inflammatory, and cardiovascular pathways. Tracking long-term mortality trends in older adults with both conditions is important as survival improves. Methods: We used CDC WONDER death certificates (adults ≥65, 1999–2023) to identify lung cancer (ICD-10 C34.x) and diabetes (E10–E14) as underlying or contributing causes. Age-adjusted and age-specific mortality per 100,000 were calculated; trends evaluated with Joinpoint regression (APC, AAPC) to guide targeted public health interventions nationwide. Results: From 1999–2023, AAMRs among U.S. adults ≥65 years with lung cancer and diabetes showed non-linear trends. Mortality increased in 1999–2003 (APC 3.70%, 95% CI 1.32–6.14), declined in 2009–2018 (APC −2.79%, −3.48 to −2.10), rose in 2018–2021 (APC 7.76%, 1.45–14.46), then declined; overall AAPC was nonsignificant (0.28%). Ages 65–74 declined in 2006–2017 (APC −3.43%), ages 75–84 declined in 2009–2018 (APC −2.65%), while ≥85 years showed a significant long-term increase (AAPC 1.94%) with a sharp rise in 2018–2021 (APC 10.10%). Men (18.95) had higher AAMRs than women (9.17); both declined in 2009–2018 (men −2.75%, women −3.04%). Black individuals had the highest AAMRs (18.30) with increases after 2015 (APC 2.25%), whereas Hispanic (9.41) (APC −1.17%) and Asian/Pacific Islander groups (10.19) (APC −5.06%) showed significant declines. Conclusions: Mortality among older U.S. adults with lung cancer and diabetes followed a non-linear course with mid-period declines and a late resurgence, notably among the oldest adults, men, and Black individuals, underscoring the need for coordinated oncologic, metabolic, and survivorship risk-reduction and targeted public health interventions nationwide.