National trends and disparities in non-cancer mortality among older adults with oral cancer in the United States, 1999-2020

TL;DR

This study examines how non-cancer deaths, especially from heart and lung diseases, are increasing among older oral cancer survivors in the U.S., with notable differences based on gender, race, and location.

Contribution

The study identifies rising non-cancer mortality trends and contributing factors among older oral cancer survivors in the U.S., highlighting demographic and geographic disparities.

Findings

Non-cancer mortality rates increased significantly after 2014, especially among females and in the Southern U.S.

Cardiovascular disease was the leading cause of non-cancer deaths across all subgroups.

Population growth and higher age-specific mortality rates were key drivers of increased mortality.

Abstract

As survival rates for oral cancer (OC) patients improve, non-cancer-related diseases, particularly cardiovascular disease (CVD) and respiratory disease (RD), pose significant threats to long-term health outcomes. Understanding shifts in non-cancer mortality is crucial for optimizing survivorship care. OC predominantly affects individuals of advanced age. This study aimed to analyze national trends in non-cancer mortality among older adults with OC and identify key factors contributing to these disparities.

Mortality data from the CDC WONDER Multiple Cause of Death database were used to examine deaths among individuals aged ≥ 65 years from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were computed, and temporal trends were assessed using Joinpoint regression. A decomposition analysis for 2015–2020 identified key factors driving recent increases in mortality rates.

A total of 7,460 non-cancer-related deaths were recorded, with 3,485 attributed to CVD (47%) and 1,472 to RD (20%). The overall AAMR was 0.837, with higher rates observed in males (1.197), White individuals (0.849), residents of the West (0.909), and those living in nonmetropolitan areas (0.874). Mortality declined from 1999 to 2014 but increased significantly thereafter (APC = 8.085), with the sharpest increases observed in females (APC = 11.358) and the Southern region (APC = 10.616). CVD mortality consistently exceeded RD mortality across all subgroups. Decomposition analysis indicated that population growth and rising age-specific mortality rates were the primary contributors to the observed increases in mortality.

Non-cancer mortality, particularly from CVD and RD, is rising among older OC survivors, with notable demographic and geographic disparities. Integrating long-term cardiopulmonary management and enhancing chronic disease prevention efforts could reduce non-cancer mortality in this vulnerable population.

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