A 25 year nationwide analysis of mortality trends from cerebrovascular diseases in patients with lung cancer (1999-2023).

Q: What are the key findings of this study?

Age-adjusted mortality from combined lung cancer and cerebrovascular disease decreased from 2.19 per 100,000 in 1999 to 1.44 in 2015, but subsequently increased to 1.71 per 100,000 in 2023.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Cerebrovascular disease and lung cancer (n=96050). Intervention: Time period (1999-2023). Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC -1.0034, 95% CI -1.3137 to -0.6921, p=<0.000001).

Q: What does this research mean for the field?

Cerebrovascular disease mortality among lung cancer patients in the U.S. decreased until 2015 but subsequently increased through 2023, disproportionately affecting men, Black adults, and populations in rural and Southern regions. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate national 25-year mortality trends and demographic disparities related to cerebrovascular disease among patients with lung cancer in the United States from 1999 to 2023.

Sarim Hassan Shahab; Aown Abbas; Siddique Ahmed; Hadia Ghazala Masood; Faria Ali; Yazdan Sajid; Warda Imran; Ilsa Fatima; Amir Rafiq; Abubakar Nazir; Awais Nazir; Muhammad Zeeshan; Mobeen Z. Haider; Ahmed Jamal Chaudhary; Ghulam Mujtaba Ghumman; Naseer Khan

doi:10.1097/ms9.0000000000005165

September 1, 2026Open Access

A 25 year nationwide analysis of mortality trends from cerebrovascular diseases in patients with lung cancer (1999-2023).

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Key result

Combined lung cancer and cerebrovascular mortality rebounds to 1.71 per 100,000 after a 2015 low.

AAPC -1.0034
95% CI -1.3137 to -0.6921
P<0.000001
n=96,050

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Key Points

To evaluate national 25-year mortality trends and demographic disparities related to cerebrovascular disease among patients with lung cancer in the United States from 1999 to 2023.
Retrospective nationwide epidemiological analysis evaluating 96,050 deaths with location information from 1999 to 2023.
Calculated age-adjusted mortality rates (AAMR per 100,000) and evaluated temporal trends using annual percent change (APC) and average annual percent change (AAPC), with significance set at P < 0.05.
Stratified mortality trends across sex, race and ethnicity, urban versus rural classifications, U.S. census regions, and states.
Overall AAMR decreased from 2.19 per 100,000 in 1999 to 1.44 in 2015 (APC: −2.8610, 95% CI: −3.1762 to −2.5448; P < 0.000001), but reversed and rose to 1.71 in 2023 (APC: 2.8192, 95% CI: 2.0376 to 3.6068; P < 0.000001), yielding an overall AAPC of −1.0034 (95% CI: −1.3137 to −0.6921, P < 0.000001).
Men maintained higher mortality than women throughout the study (decreasing from 3.08 to 1.73 before rising to 1.98 in 2023; AAPC: −1.6742, P < 0.000001), and non-Hispanic Black individuals experienced the highest burden, peaking at 2.32 per 100,000 in 2023 after an increase from 2016 (APC: 4.0477, 95% CI: 2.3663 to 5.7569, P = 0.000057).
Mortality was higher in rural areas (2.05 in 2020) than urban areas (1.53 in 2020), with Alaska (2.57), Vermont (2.46), and Mississippi (2.46) recording the highest state rates, and the South and Midwest experiencing the sharpest recent regional increases.

Study Design

Type

Observational (n=96,050)

Structured PICO

P

Population

96,050 adults aged 25 years and older in the United States who died with both cerebrovascular disease and lung cancer recorded on their death certificates between 1999 and 2023.

O

Outcome

Age-adjusted mortality rates (AAMR) per 100,000 population for cerebrovascular disease and lung cancer-related deathshard clinical

Main Result

Effect estimate: AAPC -1.0034 (95% CI -1.3137 to -0.6921)

Absolute Event Rate: 1.71% vs 2.19%

p-value: p=<0.000001

Mortality from cerebrovascular disease in patients with lung cancer in the US decreased from 1999 to 2015 but has since increased, with the highest burden observed in men, non-Hispanic Black adults, and rural areas.

Limitations

Misclassification or underreporting of cerebrovascular disorders as cause of death due to reliance on ICD coding and death certificates.
Lack of extensive clinical data such as imaging, lab results, treatment histories, or genetic information.
Inability to evaluate how specific cancer treatments and stroke therapies affected mortality outcomes.
Lack of data on social determinants of health like socioeconomic position, education, and healthcare access.
Ecological fallacy and inability to establish individual-level causal relationships.

Implication

Recent rise in combined mortality may reflect increasing cerebrovascular risk among lung cancer patients; observational trends leave open causal drivers and prevention targets.

Abstract

Introduction: The two leading causes of death worldwide are lung cancer and cerebrovascular disease (CVD). Due to complications related to the disease and therapy, patients with lung cancer are much more likely to have a stroke, particularly within 2 years after diagnosis. Results are still poor despite medical advancements, underscoring the necessity of comprehensive prevention and care. Methods: < 0.05 was considered significant. Results: < 0.0001). From 3.08 in 1999 to 1.98 in 2023, men's rates were continuously higher than women's (1.59 to 1.49). The AAMR was highest among NH Black people (it peaked at 2.32 in 2023), followed by NH Whites (1.68) and Hispanics (0.69). Rural areas had higher AAMR than Urban areas. Alaska (2.57), Vermont (2.46), and Mississippi (2.46) had the highest state level burdens, while Utah (0.64) and New Mexico (0.86) had the lowest, while the South and Midwest region saw the sharpest recent rises. Conclusion: Lung cancer mortality from CVD increased until 2023 after decreasing until 2015. The U.S. South, rural areas, Black adults, and men had the biggest burden. To lower stroke mortality in patients with lung cancer, targeted interventions are required, with a focus on addressing racial and rural disparities in care, prevention, and access.

Discussion

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Cite This Study

Shahab et al. (2026) conducted an observational in Cerebrovascular disease and lung cancer (n=96,050). Time period (1999-2023) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC -1.0034, 95% CI -1.3137 to -0.6921, p=<0.000001). Age-adjusted mortality from combined lung cancer and cerebrovascular disease decreased from 2.19 per 100,000 in 1999 to 1.44 in 2015, but subsequently increased to 1.71 per 100,000 in 2023.

synapsesocial.com/papers/6aa7afef79e9260bc85aac6c https://doi.org/10.1097/ms9.0000000000005165

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A 25 year nationwide analysis of mortality trends from cerebrovascular diseases in patients with lung cancer (1999-2023).

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

A 25 year nationwide analysis of mortality trends from cerebrovascular diseases in patients with lung cancer (1999-2023).

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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