Unveiling the trends: Growing cancer and venous thromboembolism mortality in older adults in the United States, 1999-2020

Abstract

Background: While cancer mortality rates in the United States (U.S.) have decreased due to advances in chemotherapy, older adults with cancer face an elevated risk of venous thromboembolism (VTE). This study analyzes trends in cancer-associated VTE mortality among older adults in the U.S.

Methods: Using the CDC WONDER multiple cause of death (MCD) database, we reviewed death certificates from 1999 to 2020 to assess cancer-associated VTE mortalities among older adults (≥65 years old). We report age-adjusted mortality rates (AAMRs) per 100,000 persons, along with the average annual percent change (AAPC) using Joinpoint regression.

Results: Over the study period, 175,811 cancer-associated VTE deaths were recorded. The AAMR rose from 16.8 in 1999 to 22.8 in 2020, with an AAPC of +1.4 % (95 % CI: 1.2-1.6; p < 0.001). Males had a higher AAMR (22.2) than females (17.0). Non-Hispanic (NH) Black individuals had the highest AAMR (28.3), followed by NH Whites (19.3), Hispanics (12.0), and NH Asians (7.9). AAMRs were higher in nonmetropolitan areas (19.4) than urban counterparts (19.1). Regionally, the Midwest recorded the highest AAMR at 20.9. States in the top 90th percentile reported double the AAMRs compared to those in the bottom 10th percentile.

Conclusion: Cancer-associated VTE mortality rates are rising among older adults in the U.S., highlighting the need for enhanced screening, aggressive management, and consistent surveillance for VTE in cancer patients at risk.

Keywords: Cancer; Cancer-associated venous thromboembolism; Pulmonary embolism; Venous thromboembolism.