Trends and Disparities in Cardiovascular Disease Burden Among Lung Cancer-Related Deaths in the United States, 1999–2020: A Nationwide Disproportionality Analysis

Background Cardiovascular disease (CVD) and lung cancer are among the leading causes of global mortality, often coexisting due to shared risk factors and treatment-related cardiotoxicity. However, national-level assessments of their intersection remain limited. This study aimed to evaluate long-term trends and disparities in the burden of CVD among lung cancer–related deaths in the United States. Methods We conducted a retrospective, population-based disproportionality analysis using the CDC WONDER database from 1999 to 2020. Reporting Odds Ratios (RORs) were calculated to compare the proportion of CVD-related deaths among lung cancer decedents (A/B) versus non-cancer decedents (C/D). Joinpoint regression was applied to estimate annual percentage changes (APC) and average annual percentage changes (AAPC) in RORs across demographic and geographic subgroups. Results Among 4,007,477 recorded deaths, 2,006 were attributed to lung cancer. CVD was more frequently reported among lung cancer–related deaths, particularly in younger adults (ROR 15–24: 1.839; 95% CI 1.498–2.257), males (ROR 15–24: 2.024; 95% CI 1.636–2.505), Hispanics (ROR 15–24: 2.314; 95% CI 1.844–2.907), and urban residents (ROR 15–24: 1.872; 95% CI 1.488–2.353). RORs increased from 1999 to 2020, with the highest AAPC observed in the 35–44 year age group (1.90; 95% CI 1.55–2.23). Regional disparities were evident, with higher RORs in the Northeast and West. Conclusions The burden of CVD in lung cancer–related deaths has evolved significantly over two decades, revealing persistent disparities across demographic and geographic groups. These findings highlight the growing cardio-oncologic intersection in lung cancer mortality and the need for integrated, equity-focused prevention and management strategies.