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May 30, 2026

Trends and disparities in cancer mortality among adults with psychoactive drug use disorders in United States, 1999–2023.

Key Points

This study aims to examine the trends and disparities in cancer mortality among adults with psychoactive drug use disorders in the United States from 1999 to 2023.
Analyzed CDC WONDER data for adults aged ≥25 with psychoactive drug use disorders.
Calculated age-adjusted mortality rates for cancer and assessed trends using Joinpoint regression.
Stratified the analysis by sex, race, urbanization, and geographic region.
Total cancer deaths among psychoactive drug users reached 1,899,390 from 1999 to 2023.
The age-adjusted mortality rate (AAMR) increased from 4.85 in 1999 to 34.33 in 2023 (AAPC: 9.50%; p < 0.001).
Non-Hispanic Whites exhibited the highest AAMR, while the Midwest region had the highest mortality rates.

Abstract

e15132 Background: Psychoactive drug use is a growing public health concern and is linked to increased cancer risk through biological effects and associated high-risk behaviors. However, population-level data on cancer mortality among psychoactive drug users remain limited, highlighting the need to examine trends and disparities to inform prevention and public health strategies. Methods: We analyzed CDC WONDER data to estimate age-adjusted mortality rates (AAMRs) for cancer (ICD-10 C00–C48) among adults aged ≥25 years with psychoactive drug use disorders (ICD-10 F10–F19). Temporal trends and average annual percent changes (AAPCs) were assessed using Joinpoint regression, stratified by sex, race, and geographic factors, including urbanization and census region. Results: From 1999 to 2023, cancer among psychoactive drug users accounted for 1,899,390 deaths (744,099 females and 1,273,561 males), with most deaths occurring at the decedent’s home (43.4%) and predominantly among older adults. The AAMR increased from 4.85 in 1999 to 34.33 in 2023 (AAPC: 9.50%; p < 0.001), with significant rises during 1999–2005 (APC: 41.65; 95% CI: 31.90–52.12) and 2005–2012 (APC: 4.70; 95% CI: 1.03–8.51), followed by a significant decline through 2023 (APC: −2.09; 95% CI: −3.37 to −0.79). Men consistently exhibited higher AAMRs than women from 1999 (7.03 vs. 3.22) to 2023 (45.38 vs. 25.26). Non-Hispanic(NH) Whites had the highest AAMR, followed by NH American Indian or Alaska Native,NH Blacks and Hispanic or Latino populations, while Asians or Pacific Islanders had the lowest rates. Regionally, the Midwest showed the highest AAMR, whereas the West had the lowest. Non- metropolitan populations had higher average AAMRs than metropolitan populations (55.36 vs. 32.29). From 1999 to 2020, Vermont ranked highest in the top 90th percentile, while from 2020 to 2023, Kentucky held the highest rank. Conclusions: Cancer mortality among psychoactive drug users remains a major public health concern, with higher rates observed among older adults, males, Black populations, and rural residents, underscoring the need for targeted prevention, early detection, and equitable, integrated care. Deaths and Age-adjusted Mortality Rates (AAMRs) per 100,000 for trends related to Cancer among psychoactive drug users from 1999 to 2023. Variable Deaths AAMR (95%CI) 1999 AAMR (95% CI)2023 Overall 1,899,390 4.79(4.69 to 4.89) 43.29(43.02 to 43.56) Male 1,273,561 6.29(6.12 to 6.46) 53.43 (53.01 to 53.87) Female 744,099 3.42(3.3 to 3.53) 33.63 (33.30 to 33.97) NH Whites 1,634,542 5.35 (5.22 to 5.47) 57.97(57.58 to 58.37) NH Blacks 177,341 5.22 (4.9 to 5.54) 33.52(32.84 to 34.19) Midwest 569,261 4.45 (4.24 to 4.65) 64.63 (63.90 to 65.36) West 273,007 5.82 (5.58 to 6.06) 25.83 (25.40 to 26.27) Metro 1,225,615 (2020) 4.36 (4.26 to 4.47) (2020) 40.13 (39.85 to 40.41) Non- metro 375,699 7.02 (6.72 to 7.33) 79.96 (78.98 to 80.94)

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