Abstract 4146125: Demographic, Regional Trends and Place of Death of Cardiovascular Disease−Related Mortality in Colorectal Cancer in the United States (1999 to 2020)

Background: Patients with colorectal cancer (CRC) are 2-4 times more likely to develop cardiovascular disease (CVD), likely due to shared risk factors and the effects of chemo-radiotherapy. Despite existing evidence of increased CVD mortality in CRC, there remains a need for a comprehensive nationwide study. Methods: We utilized death certificates from the CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) database from 1999 to 2020 to evaluate the trends of CVD-related mortality in CRC patients using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and Annual Percentage Change (APCs) with 95% CI were stratified by year, sex, race/ethnicity, geographic region and place of death (POD). Results: Between 1999 and 2020, there were 1,304,077 deaths related to CRC in the United States. Of these, 414,367 (31.8%) deaths were related to CVD. The overall CRC + CVD related AAMR was 7.8 in 1999 and 4.6 in 2020 (Figure 1). The AAMRs of CRC + CVD deaths decreased at an APC of -3.69 (95%CI, -3.4 to -4.09) from 1999 to 2016; followed by an increase in AAMRs from 2016 to 2020 at an APC of 0.76 (95%CI, -1.29 to 5.4). Of the 387,618 CRC + CVD deaths with location available on POD, 153,114 (39.5%) occurred in medical facility, 128,728 (33.2%) in homes, 88,064 (22.7%) in nursing homes/long-term care and 17,712 (4.57%) in hospice facility. Males had higher overall AAMRs than females (7.1 vs. 4.6) which increased from 2016 to 2020 (APC 0.95); Black and African Americans had the highest AAMRs (7.8) which increased steadily by 5.1% from 2018 to 2020. Asian or Pacific Islander had the lowest AAMRs (3.9), however the rates increased by 4.4% in recent years between 2018 and 2020. Northeast region had the highest AAMR (6.7) while South had the lowest (5.0). The AAMRs was highest in rural (6.3) followed by urban (5.9), this gap widened in recent years as AAMR increased for rural (APC 1.7 from 2018 to 2020), while urban remained stable (APC -1.00 from 2016 to 2020). Conclusion: There has been a rising trend in CRC + CVD-related mortality in recent years despite an initial decrease for over a decade. Higher rates of hospital deaths and decreased usage of hospice facility was noted indicating lack of end-of-life-care. Significant demographic and geographic disparities exist amongst certain socioeconomic groups with increased mortality in recent years.