What is the clinical evidence from this study?

Study design: Observational. Population: Cardiac, mediastinal, and pleural malignancies (n=5424). Primary outcome: Overall age-adjusted mortality rate trend (Average Annual Percent Change) (AAPC -4.325%, 95% CI -4.890 to -3.191, p=<0.001).

May 8, 2026Open Access

Mortality trends of cardiac, mediastinal and pleural malignancies in the United States, 1999–2020: a population-based analysis of demographic and geographic disparities

Q: What are the key findings of this study?

Overall mortality from cardiac, mediastinal, and pleural malignancies in the United States significantly declined from 1999 to 2020, with an average annual percent change of -4.325%.

Key Result

Overall mortality from cardiac, mediastinal, and pleural malignancies in the United States significantly declined from 1999 to 2020, with an average annual percent change of -4.325%.

Study Design

Type

Observational (n=5,424)

Structured PICO

Population

Adults (≥18 years) who died from cardiac, mediastinal, or pleural malignancies (ICD-10 code: C38) in the United States between January 1, 1999, and December 31, 2020 (n=5,424).

Outcome

Age-adjusted mortality rates (AAMRs) and temporal trends (annual percent changes and average annual percent changes)hard clinical

Mortality from cardiac, mediastinal, and pleural malignancies in the United States has significantly declined from 1999 to 2020, although substantial demographic and geographic disparities persist.

Main Result

Effect estimate: AAPC -4.325% (95% CI -4.890 to -3.191)

p-value: p=<0.001

Limitations

Reliance on death certificate accuracy, which may be subject to diagnostic errors or inaccurate coding.
Absence of individual-level clinical information such as tumor staging, treatment regimens, and comorbidities.
Study period spanned ICD coding system transitions and diagnostic technology advances, potentially introducing detection bias.
The 2020 COVID-19 pandemic may have affected data quality.
Insufficient case numbers in certain states and minority ethnic groups limited trend analyses.
Analysis of mortality rather than incidence rates precludes differentiating between reduced incidence versus improved survival.
Exclusion of mediastinal lymphomas (ICD-10 C81-C86) from the analysis.
Inability to conduct subcode-level trend analysis due to small annual death counts.
Inherent biological and clinical heterogeneity of tumors classified under ICD-10 code C38.

Abstract

Background Cardiac, mediastinal, and pleural malignancies represent rare but clinically significant thoracic neoplasms. Despite their clinical importance, comprehensive epidemiological analyses of mortality trends for these tumors remain limited. This study aimed to analyze mortality trends and demographic disparities of these malignancies in the United States from 1999 to 2020. Methods We conducted a retrospective observational study using the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Adults (≥18 years) who died from cardiac, mediastinal, or pleural malignancies (ICD-10 code: C38) between January 1, 1999, and December 31, 2020, were included. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, age, race/ethnicity, geographic region, and urbanization level. Joinpoint regression analysis was employed to identify temporal trends, with calculation of annual percent changes (APCs) and average annual percent changes (AAPCs). Results During the study period, 5,424 deaths were attributed to cardiac, mediastinal, or pleural malignancies, with an overall AAMR of 0.109 per 100,000 population (95% CI: 0.105-0.112). Males demonstrated higher mortality rates than females (0.133 vs. 0.076 per 100,000). Elderly individuals (≥65 years) accounted for 65.08% of total deaths. Overall mortality exhibited a significant declining trend (AAPC: -4.325%; 95% CI: -4.890 to -3.191; P0.001), characterized by rapid initial decline from 1999-2001 (APC: -15.245%; P0.001), followed by a more gradual decrease from 2001-2020 (APC: -3.096%; P = 0.044). Significant disparities were observed across demographic and geographic variables. White individuals had the highest AAMR (0.109 per 100,000), followed by African Americans (0.097) and Hispanic or Latino populations (0.059). Geographic analysis revealed the highest mortality rates in the Western region (0.131 per 100,000) and lowest in the Midwest (0.085). Metropolitan areas demonstrated more pronounced mortality decline (AAPC: -3.922%) compared to non-metropolitan areas (AAPC: -2.309%). State-level analysis revealed substantial heterogeneity, with Washington State exhibiting the highest AAMR (0.172 per 100,000) and Connecticut the lowest (0.056). Conclusions Over the past two decades, mortality from cardiac, mediastinal, and pleural malignancies in the United States has significantly declined; however, substantial demographic and geographic disparities persist. These findings underscore the need for targeted interventions to address regional disparities and ensure equitable access to early detection and treatment strategies across all populations.

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