Nationwide trends in mortality with concurrent colorectal cancer and chronic ischemic heart disease: A CDC WONDER analysis (1999–2020).

e15721 Background: Co-mortality from colorectal cancer (CRC) and chronic ischemic heart disease (CIHD) is increasingly relevant in an aging population, yet contemporary U.S. trend patterns and disparities are incompletely described. Methods: Using CDC WONDER Death data (1999–2020), we identified deaths listing CRC (ICD-10 C18–C20) and CIHD (I25). We calculated age-adjusted mortality rates (AAMRs) per 100,000 using the 2000 U.S. standard population and evaluated temporal changes with Joinpoint regression (annual percent change APC and average annual percent change AAPC), with stratification by sex, age group, race/ethnicity, U.S. Census region, and urban-rural status. Results: We identified 99,083 deaths with CRC and CIHD listed. Overall, AAMRs declined significantly (AAPC −4.37%, 95% CI −4.83 to −3.92; P < 0.05). Men had higher mortality than women (AAMR 3.10 vs 1.41), and both sexes showed significant overall declines (women AAPC −5.19%, 95% CI −5.93 to −4.46; P < 0.05; men AAPC −4.05%, 95% CI −4.61 to −3.49; P < 0.05). Segmentally, women declined significantly from 1999–2006 (APC −4.72%, P < 0.05) and 2006–2017 (APC −7.27%, P < 0.05), followed by a non-significant incline thereafter. Men similarly declined significantly from 1999–2006 (APC −4.04%, P < 0.05) and 2006–2016 (APC −6.01%, P < 0.05), with a later non-significant reversal. By age, the 45–54 group showed a non-significant upward trend (APC 1.32%, 95% CI −0.05 to 2.70; P = 0.058), while ages 55–64 transitioned from a significant decline through 2017 (APC −3.77%) to a significant increase thereafter (APC 9.76%). Racial/ethnic burdens were highest among non-Hispanic (NH) White (AAMR 2.15) and NH Black individuals (AAMR 1.94), and AAMRs declined significantly across groups (e.g., Asians AAPC −4.34%, P = 0.013; NH Black AAPC −4.34%, P < 0.05; NH White AAPC −4.33%, P < 0.05; and Hispanics AAPC −4.27%, P < 0.05). Regionally, AAMR was highest in the Northeast (2.54) and Midwest (2.37); all regions declined significantly overall (e.g., Northeast AAPC −5.54%, P < 0.05; South AAPC −3.18%, P < 0.05), with a non-significant rebound in the Northeast after 2018. Nonmetropolitan areas had higher AAMR than metropolitan areas (2.47 vs 1.99), and both showed significant overall declines (metro AAPC −4.60%, P < 0.05; nonmetro AAPC −3.26%, P < 0.05). State AAMRs ranged from 0.94 (Utah) to 3.38 (West Virginia). Conclusions: CRC–CIHD co-mortality overall declined substantially from 1999–2020 but has recently plateaued, with concerning midlife increases and persistent rural and regional disparities. These findings support targeted, equity-focused integration of CRC screening/early detection with cardiovascular risk prevention and management, particularly for vulnerable subgroups.