Mortality trends in US patients with gynecologic cancer and cardiovascular disease

OBJECTIVES: Female genital organ cancers and cardiovascular disease (CVD) are major contributors to women's morbidity and mortality. Improved cancer survival and increasing cardiometabolic risk may amplify their coexistence, yet population-level mortality patterns remain unclear. METHODS: This study analyzed US national death certificate data (1999-2023) for women aged ≥25 years with both gynecologic cancer (ICD‑10 codes C51-C58) and CVD (ICD‑10 codes I00-I99). Age-adjusted mortality rates (AAMRs) were calculated using the 2000 US standard population. Joinpoint regression estimated the annual percentage change (APC) and average annual percentage change (AAPC), stratified by age, race, region and urbanization. RESULTS: A total of 210,966 deaths were identified, representing a 49.0% increase over the study period. The overall AAMR remained stable (7.50-7.62 per 100,000; AAPC 0.01%). Mortality was highest among women aged ≥85 years, with a marked rise after 2018 (APC 5.55%). The West showed sustained increases, whereas the Northeast experienced early declines. Non-Hispanic Black women and non-metropolitan residents consistently had the highest mortality. CONCLUSION: Although overall mortality remained stable, substantial age, racial, geographic and rural-urban disparities persist. These findings highlight the need for integrated cardio-oncology care and targeted strategies to reduce structural inequities.