Trends and disparities in malignant neoplasms and Alzheimer's disease–related mortality in the United States, 1999-2023.

e23363 Background: Malignant neoplasms and Alzheimer’s disease contribute a major mortality burden in U.S. adults. The combined effects of tumor progression and neurodegeneration heighten risk and severity. This study aims to evaluate mortality trends in the United States from 1999 to 2023, stratified by various demographic and geographic factors. Methods: The mortality data from the CDC WONDER multiple cause of death files for adults aged ≥65 years were used to analyze age-adjusted and crude mortality rates (AAMRs and CMRs) per 100,000 through ICD-10 Codes: C00-C97 (malignant neoplasms) and ICD-10 Codes: G30.0, 30.1, 30.8 and 30.9 (Alzheimer’s disease), stratified by year, gender, race/ethnicity, place of death and geography. Joinpoint regression was used to estimate the average annual percent change (AAPC) and the annual percent change (APC) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. Results: From 1999 to 2023, a total of 142,770 deaths were reported among patients of malignant neoplasms and Alzheimer’s disease, most occurring in nursing homes or long-term care facilities. The overall AAMR declined from 13.9 in 1999 to 12.1 in 2023 (AAPC: -0.69; 95% CI: -1.37 to -0.01), with an initial increase until 2006 (APC: 1.50), a sharp decline through 2014 (APC: -4.57), and a subsequent rise in 2021 (APC: 2.81). Men had a higher AAMR (16.34 vs 11.84), but a more pronounced decline in mortality than women (AAPC: -1.12 vs -0.51). Adults aged 85+ years had the highest CMR (60.30). The highest AAMR was observed among non-Hispanic (NH) Blacks (14.39), while the lowest AAMR was noted in NH Asians (6.61). Geographic disparities were evident, with the West having the highest AAMR (16.11) and the Northeast having the lowest AAMR (10.47). Non-Metropolitan (15.51 vs 13.10) areas showed higher AAMR and a mortality decline less than that of metropolitan areas (AAPC: –0.38 vs –0.48). At the state level, North Dakota (24.27) and Oregon (29.40) ranked highest, placing in the top 90th percentile during 1999–2020 and 2021–2023, respectively. Conclusions: Mortality among patients of malignant neoplasms and Alzheimer’s disease has declined over the past two decades, with disproportionate effects observed in older men, NH Blacks, and those in non-metropolitan areas and the West region. These persistent disparities underscore the need for targeted prevention, early detection, and equitable, integrated care for vulnerable populations. Annual average percent change of AAMR for Malignant Neoplasms and Alzheimer's Disease in the United States, 1999 to 2023. Variable Deaths AAPC (95%CI) Overall 142,770 -0.69 (-1.37 to -0.01) Male 63,812 -1.12 (-2.05 to -0.18) Female 78,958 -0.51 (-1.16 to 0.15) Non-metropolitan areas 25,428 -0.38 (-1.07 to 0.32) Metropolitan areas 97,999 -0.48 (-1.01 to 0.06)