Cardio-Oncologic Mortality Surveillance: Rising Trends of Arrhythmia- Associated Deaths in Lung Cancer Patients, United States 1999-2023

Background: Lung cancer (LC) and arrhythmias frequently coexist, posing significant challenges in clinical management. The interplay between these conditions can exacerbate hemodynamic instability and influence treatment outcomes. This study aimed to assess the impact of arrhythmias on mortality and disparities in patients with LC. Methods: We analyzed death certificates of adults aged > 25 years from the CDC-WONDER database with LC (ICD-10 codes: C34) and arrhythmias (ICD-10 codes: I44, I45, I47, I48, and I49) from to 1999–2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, and year. Join-point analysis was performed to estimate the annual percent change (APC) and average annual percent change (AAPC) in mortality trends. Results: Between 1999 and 2023, LC and arrhythmias caused 132,085 deaths in adults aged > 25 years. The AAMR first increased from 18.98 in 1999 to 25.06 in 2018 (APC: 1.32, 95% CI: 1.18–1.46), further increased to 30.4 in 2021 (APC: 7.13; 95% CI: 5.53–8.05) and finally decreased to 29.98 in 2023 (APC: -0.61; 95% CI: -2.31 to 1.20) with an overall AAPC (1.87; 95% CI: 1.74–1.99). The AAMR for males in 2023 (39.09) was higher than that for females (22.86). The AAMR for non-Hispanic (NH) White in 2023 displayed the highest AAMR (34.32), followed by NH Black or African American (25.46), NH American Indian or Alaska Native (21.14), NH Asian or Pacific Islander (12.9), and Hispanic or Latino (11.17). Geographically, the AAMR for the South region in 2023 showed the highest AAMR (33.11), followed by the Midwest (32.13), West (26.25), and Northeast (25.7). From 1999–2020, Rural areas exhibited a higher AAMR (37.3) than urban areas (26.41). Conclusion: LC and arrhythmia-related mortalities have increased, with the highest rates among males, White individuals, and those in the southern and rural regions. These disparities highlight the need for targeted interventions and improvements in clinical care facilities for high-risk populations.