e22602 Background: Cancer mortality in the United States has declined over the past two decades, reflecting advances in prevention, early detection, and treatment; however, these gains have not been equitably realized across all populations. Substance use disorder (SUD) often coexists with cancer and may be associated with worse outcomes through delayed engagement with cancer care, treatment interruptions, and coexisting substance-related conditions. National patterns of cancer mortality occurring in the context of SUD have not been studied. We examined national trends and disparities in cancer deaths with co-occurring substance use disorder. Methods: We conducted a retrospective, cross-sectional analysis of the CDC WONDER database from 1999-2020. Cancer was defined as the underlying cause of death, with substance use disorder listed as a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population and stratified by sex, race and ethnicity, urbanization level, and cancer site. Temporal trends were assessed using joinpoint regression, with results expressed as annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Results: From 1999 to 2020, cancer mortality with co-occurring SUD increased significantly from 4.3 to 36.7 per 100,000 (AAPC 11.09%; 95% CI 9.71-12.62; p < 0.000001). Mortality rates were higher among males than females (44.6 vs 23.1 per 100,000; p = 0.00006), with significant increases over time in both groups (male AAPC 11.0% 9.5-12.5; female 11.0% 10.0-12.8). Rates were higher in rural compared to urban populations (43.6 vs. 30.1 per 100,000; p = 0.01). By race and ethnicity, the highest AAMRs were observed among non-Hispanic White (35.9), American Indian/Alaska Native (35.5), and non-Hispanic Black individuals (31.0), while Asian (8.4) and Hispanic/Latino populations (11.7) had lower rates (p < 0.0001). All racial and ethnic groups showed significant increases in AAPC over the study period. Conclusions: Despite overall declines in U.S. cancer mortality, deaths occurring in the context of substance use disorder have risen markedly over the past two decades, with pronounced disparities by sex, race and ethnicity, and rural residence. These findings suggest that individuals with co-occurring substance use disorder have not fully benefited from advances in cancer care, likely reflecting delayed engagement, treatment disruptions, and structural barriers. Targeted strategies integrating cancer care with substance use services are needed to reduce these widening mortality gaps.
Akoto et al. (Thu,) studied this question.