Disparities in Lung Cancer Death Among People with Chronic Lower Respiratory Diseases in the United States

Purpose: Patients with chronic lower respiratory diseases (CLRD) are at a higher risk of lung cancer. Less is known regarding how the risk of CLRD-associated lung cancer death might have changed on a national scale over the past 20 years across demographic and regional groups.

Methods: We calculated age-adjusted mortality rates (AAMR) for lung cancer death among people with CLRD using 1999-2020 data from the CDC WONDER multiple cause of death database. Rates were compared between demographic groups and time periods.

Results: Rates of lung cancer death among people with CLRD were highest among White Americans compared to other racial groups. Elevated rates of lung cancer death were seen among men (AAMR = 25.054, 95% CI: 24.960-25.148) and those aged 65 + (AAMR = 44.776, 95% CI: 44.638-44.913) compared to their counterparts. Rates were higher in the Midwest (AAMR ratio = 1.410, 95% CI: 1.401-1.418) and the South (AAMR ratio = 1.290, 95% CI: 1.282-1.298) compared to the Northeast. Rates were elevated in rural areas (AAMR ratio = 1.444, 95% CI: 1.438-1.451). Between 1999 and 2004 and 2016-2020, the AAMR of CLRD-associated lung cancer death decreased from 21.647 (95% CI: 21.528-21.765) to 17.221 (95% CI: 17.123 - 17.318). Rates decreased over time across demographic groups.

Conclusion: CLRD-associated lung cancer deaths significantly decreased in the United States between 1999 and 2020. Despite this progress, White people, men, older adults (65 +), and people in rural areas continue to experience higher CLRD-associated lung cancer mortality rates than their counterparts.