Trends and patterns of lung cancer among psychoactive substance–using older adults in the United States 1999-2024: A CDC WONDER analysis.

e20086 Background: Lung cancer remains a leading cause of cancer-related morbidity and mortality in the United States. Cigarette smoking accounts for approximately 80-90% of lung cancer deaths and increases lung cancer risk by 15 to 30 fold compared to never smoking. Growing evidence suggests that other inhaled psychoactive substances may significantly increase the risk of lung cancer. Psychoactive substance use usually co-occurs with tobacco use. Methods: Using the CDC WONDER multiple cause of death (MCOD) database, we reviewed death certificates from 1999 to 2024 to assess lung cancer mortality trends among psychoactive substance-using older adults (≥ 65 years) in the US. We report age-adjusted mortality rates (AAMRs) per 100,000 persons, along with the average annual percent change (AAPC) and annual percent change (APC) using Joinpoint regression. Results: Over the study period, 1,015,383 lung cancer-associated psychoactive substance use deaths were recorded. The AAMR rose from 11.8 in 1999 to 80.7 in 2024, with an AAPC of 8.61 (95 % CI: 6.56 to 10.69). Overall, males had higher AAMRs than females, with a value of 8.6 in 1999, which rose to 99.5 in 2024. NH White individuals had the highest AAMR compared to all other races, rising from 12.0 in 1999 to 92.8 in 2024. The most common place of death was the decedent's home, accounting for 43.6% of the total deaths. Non-metropolitan areas had higher AAMRs compared to metropolitan areas, rising from 14.4 in 1999 to 132.5 in 2020. Regionally, the Midwest recorded the highest overall AAMRs, which increased from 10.9 in 1999 to 118.4 in 2024. States in the top 90th percentile reported AAMRs 20 times higher than those in the bottom 10th percentile. Conclusions: Lung cancer mortality among adults using psychoactive substances in the US is increasing and shows significant demographic and geographic disparities, highlighting the need for integrated prevention efforts. Future research should investigate the independent and combined effects of specific psychoactive substances on lung cancer risk to assess the precision of mortality data.