Citations

e17594 Background: Cardiovascular disease (CVD) is the leading cause of death among women with ovarian cancer. This study investigates cardiovascular mortality in women with ovarian cancer across the United States, assessing trends by geography and urbanization. Methods: Mortality data from the CDC WONDER database (1999–2020) were analyzed. Females with ovarian cancer listed on the death certificate and cardiovascular disease as the cause of death were identified using ICD-10 codes. Age-adjusted mortality rates (per 100,000) were calculated and stratified by census region and urbanization. Trends were evaluated using Average Annual Percent Change (AAPC) calculated by the Joinpoint Regression Program V5.4.0. Results: From 1999 to 2018, cardiovascular mortality in ovarian cancer patients declined, with an APC of –2.09%, consistent across regions and urbanization levels. However, from 2018 to 2020, a concerning reversal occurred, with mortality increasing by +3.79% per year. The abrupt rise in mortality is observed in the Midwest region, with an APC of +3.99, and in small and medium metro regions, with APCs of +7.38 and +6.46, respectively. This reversal in cardiovascular mortality in ovarian cancer from 2018 to 2020 is likely due to the COVID-19 pandemic that disrupted screening and treatment. Conclusions: This 21-year analysis demonstrates a long-term decline in cardiovascular mortality among women with ovarian cancer, followed by a sharp reversal from 2018 to 2020. This increase suggests the urgent need for public health interventions to reduce cardiovascular risk among ovarian cancer patients.

e17524 Background: Cervical cancer remains one of the leading causes of female cancer mortality, while heart failure drives chronic disease burden. Their coexistence complicates outcomes through shared risk factors, cardiotoxicity, and mortality. This study examined cervical cancer mortality trends in patients with heart failure, assessed disparities, and aimed to inform integrated management strategies. Methods: We analyzed death certificates from CDC WONDER Database (1999–2020), using ICD-10 C53 (cervical cancer) and I50 (heart failure). Female mortality was stratified by race and urbanization. Joinpoint Regression Program V5.4.0 calculated Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Results: A total of 5,534 deaths were identified. Age-adjusted mortality rates (AAMR) declined overall, but trends varied. Among females, mortality fell from 0.1102 per 100,000 in 1999 to 0.076 in 2020 (AAPC -1.28%). Three phases emerged: a modest decline (1999-2006, APC -1.45%), a rapid decline (2006-2009, APC -17.6%), and a concerning reversal (2009-2020, APC +3.27%). The latter increase may reflect reduced screening, declining vaccination rates, or COVID-19 disruptions.By urbanization, large central metropolitan areas showed a steady decline (APC -4.13%). By race, White women demonstrated a consistent reduction (APC -2.61%), indicating sustained benefits of screening and vaccination. Conclusions: Cervical cancer mortality in heart failure patients declined from 1999-2020, reflecting prevention and healthcare advances. However, disparities persist, with notable increases among women since 2009. These findings highlight successes but stress the urgent need for vaccination and screening.

e17104 Background: Prostate cancer is a commonly diagnosed malignancy among men. Sepsis continues to pose a significant threat to outcomes. Patients with are particularly vulnerable to sepsis due to immunosuppression from the malignancy itself, advanced age, and treatment-related factors including catheter use. Sepsis is associated with high short-term mortality, and worsened overall outcomes, underscoring the need for epidemiological and clinical evaluation. Methods: We analyzed death certificates from 1990-2023 from CDC Wonder Database. We used ICD-10 codes, C61 for malignant neoplasm of prostate and C56 for sepsis to identify related deaths. Mortality rates were compared by urbanization, sex and census region. Joinpoint Regression Program V5.4.0 computed Annual Percent Change with 95% CIs. p value < 0.05 was considered statistically significant. Results: Between 1999 and 2023, 39,801 deaths were recorded. Overall age-adjusted mortality rates (AAMRs) changed little over time, remaining near 2 deaths per 100,000 population (2.02 in 1999 and 2.00 in the most recent year). Clear differences were seen across demographic groups.In 1999, AAMRs among Black or African American was highest with value of 6.80 compared to white and hispanic or latino individual with AAMR vales 1.67 and 1.89 respectively.In 2023, mortality among Black individuals fell to 5.06; however, rates were still higher than those seen among White (1.76) and Hispanic/Latino (1.92) populations. Geographic differences were also evident.The mortality rate in the South, decreasing from 2.43 in 1999 to 2.16 in 2023, was highest among all the other census regions.Mortality rates declined across both metropolitan and nonmetropolitan areas, falling from 2.02 to 1.84 in metropolitan regions and from 2.05 to 1.73 in nonmetropolitan regions in year 2020. Conclusions: Overall sepsis-related mortality has remained relatively unchanged over the two decades, with significant racial and geographic disparities. Black individuals continue to experience disproportionately higher mortality, and Southern region showed consistently elevated rates. Both metropolitan and non-metropolitan areas saw modest declines. These findings highlight the continued need for targeted preventive measures and management strategies to reduce mortality and improve outcomes. Prostate cancer with sepsis AAMRs. variable AAMR 1999 AAMR 2023 Overall / Male 2.02 (1.91-2.14) 2.00 (1.92-2.09) Race Black or African American 6.80 (6.04-7.56) 5.06 (4.60-5.53) White 1.67 (1.56-1.78) 1.76 (1.67-1.85) Hispanic or Latino 1.89 (1.39-2.50) 1.92 (1.65-2.20) Census Region Northeast 2.25 (2.00-2.51) 1.99 (1.80-2.18) Midwest 1.71 (1.50-1.92) 1.65 (1.49-1.81) South 2.43 (2.22-2.63) 2.16 (2.02-2.30) West 1.54 (1.33-1.76) 2.12 (1.94-2.30) Urbanization AAMR 2020 Metro 2.02 (1.90-2.15) 1.84 (1.75-1.93) Non-metro 2.05 (1.79-2.30) 1.73 (1.54-1.92)

e16067 Background: Gastric carcinoma remains a significant cause of cancer mortality in the United States. Although overall mortality rates have declined, persistent disparities exist across racial, age, and geographic groups. For cancer patients, sepsis—a life-threatening infection response—is a major fatal complication. Analyzing linked mortality data is crucial for identifying high-risk populations, understanding the burden of cancer-associated infections, and guiding targeted prevention and treatment strategies to improve outcomes and achieve health. Methods: This cross-sectional study used CDC WONDER mortality data from 1999–2020 for adults aged 25 years and older. Causes of death were identified using ICD-10 codes, and age-adjusted mortality rates (AAMRs) were calculated across sex, race/ethnicity, age, census regions, and urban–rural categories. Mortality trends were assessed using Joinpoint regression to estimate average annual percentage changes (AAPC) with 95% confidence intervals (CIs) and statistical significance. Results: From 1999 to 2020, U.S. stomach cancer mortality declined overall, with AAMRs decreasing from 0.29 to 0.22 per 100,000 (AAPC = –0.8%, 95% CI: –1.64 to 0.04). Significant declines occurred among adults aged 65–74 (APC = –1.7%, 95% CI: –2.32 to –1.05), 75–84 (APC = –1.9%, 95% CI: –2.65 to –1.05), and ≥85 years (APC = –3.0%, 95% CI: –4.02 to –1.99). Adults 45–54 years experienced increasing mortality after 2005 (APC = 5.1%, 95% CI: 2.82 to 7.46), while rates among 55–64 years remained stable. Male mortality declined significantly (AAPC = –1.24%, 95% CI: –1.93 to –0.54), whereas female mortality showed no significant long term change (AAPC = –0.93%, 95% CI: –2.44 to 0.60). Black (AAPC = –2.25%, 95% CI: –3.02 to –1.47) and Hispanic/Latino populations (AAPC = –1.50%, 95% CI: –2.26 to –0.74) experienced significant declines. Regionally, the Northeast showed the largest decline (AAPC = –2.30%, 95% CI: –3.52 to –1.07), while the Midwest, South, and West demonstrated no significant long term trends. Metropolitan areas declined from 1999–2011 (APC = –2.80%, 95% CI: –4.44 to –1.14). Conclusions: While overall U.S. gastric cancer mortality declined from 1999–2020, this progress is uneven. Significant increases among adults aged 45–54 and stable rates for those 55–64 highlight an emerging concern. Furthermore, declining trends are concentrated in specific demographic groups and regions, such as the Northeast, revealing persistent disparities. These findings underscore the need for targeted prevention and research focused on younger adults and lagging geographic areas.

ABSTRACT Background Lung cancer (LC) and respiratory failure (RF) are leading causes of adult mortality worldwide. Analyzing long‐term mortality trends across demographic, racial, geographic, and socioeconomic groups is essential to address disparities and enhance outcomes. This study investigates US national mortality patterns for LC and RF from 1999 to 2023, focusing on changes in age‐adjusted mortality rates (AAMRs) and key disparities. Methods Mortality data from the CDC WONDER database (1999–2023) for adults aged 25+ with LC (ICD‐10: C34) or RF (ICD‐10: J96) were analyzed. AAMRs per 100,000 were calculated, stratified by gender, race/ethnicity, region, state, and urban–rural status. Temporal trends were assessed using Joinpoint regression to estimate annual percent changes (APCs) with 95% confidence intervals (CIs), with significance at p < 0.05. Results Over 1999–2023, 456,325 deaths from LC and RF were recorded. AAMRs declined from 1999 to 2010 (APC = −1.2, 95% CI: −1.6 to −0.9) but rose from 2010 to 2023 (APC = 1.4, 95% CI: 1.1–1.7). Men's AAMRs steadily decreased, whereas women's dropped initially, then increased from 2011 to 2023 (APC = 2.0, 95% CI: 1.7 to 2.5). Non‐Hispanic Whites saw a sharp AAMR rise from 2014 to 2017 (APC = 2.7, 95% CI: 0.9 to 3.3), with other racial/ethnic groups showing mixed trends. Regionally, the Northeast had the highest AAMRs (8.6, 95% CI: 8.5 to 8.7), and the Midwest the lowest (7.1, 95% CI: 7.0 to 7.1). Metropolitan areas saw increases post‐2006, whereas nonmetropolitan areas rose after 2009 (APC = 2.3, 95% CI: 1.8–3.1). Mississippi had the highest state AAMR (14.0, 95% CI: 13.7–14.4), Wisconsin the lowest (3.7, 95% CI: 3.5–3.8). Conclusion LC and RF mortality declined until 2010, then increased, revealing significant disparities. Targeted interventions are critical to address these trends and reduce inequities.

e20520 Background: Cancer and respiratory failure (RF) are amongst leading causes of mortality in adults. This study investigates national trends in age-adjusted mortality rates (AAMRs) for cancer and RF in the United States from 1999 to 2023, focusing on disparities by gender, race, region, and rural-urban residence to inform public health strategies. Methods: This descriptive study analyzed data from the CDC WONDER database, of adults aged 25 and older. Mortality data were identified using ICD-10 codes C00–C97 (cancer) and J96 (RF). AAMRs per 100,000 population were calculated and stratified by gender, race/ethnicity, census region, urban-rural classification, and state. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Results: From 1999 to 2023, total deaths of 1,263,368 attributed to cancer and RF (682,141 men, 581,227 women). AAMRs declined from 1999 to 2004 (APC = -1.5, 95% CI: -4.0 to -0.4), stabilized from 2004 to 2012 (APC = 0.8, 95% CI: 0.1 to 2.4), and increased from 2012 to 2023 (APC = 3.2, 95% CI: 2.9 to 3.8). Men experienced a greater initial decline (APC = -2.1, 1999–2004) but significant increases thereafter (APC = 3.0, 2012–2023), while women showed a slower decline followed by sharper increases (APC = 3.5, 2013–2023). Non-Hispanic Black populations initially declined (APC = -1.7, 1999–2003) but later increased significantly (APC = 3.0, 2014–2020). Hispanic/Latino populations declined (APC = -1.2, 1999–2009) before rising sharply (APC = 3.1, 2009–2020). American Indian or Alaska Native populations showed consistent increases (APC = 1.7, 1999–2020). Urban areas experienced initial declines (APC = -1.7, 1999–2004), followed by increases (APC = 2.4, 2011–2020). Non-metropolitan areas exhibited steeper increases (APC = 4.6, 2014–2020). Regionally, the West recorded the highest AAMR (24.0), followed by the Northeast (23.6), South (20.9), and Midwest (18.0). Mississippi had the highest state-level AAMR (36.3), while Wisconsin had the lowest (10.0). States in the top 90th percentile included Mississippi, Arkansas, and California, while Wisconsin, Minnesota, and Oregon were among the lowest. Conclusions: Cancer and RF mortality declined initially but have significantly increased in recent years. Disparities persist across gender, racial, and regional groups, underscoring the need for focused public health efforts and equitable resource distribution to address these trends.

e16001 Background: Esophageal carcinoma ranks among the top 10 malignancies in the world, contributing to high morbidity and mortality. With radiotherapy being one of the most administered treatment options, different variations of administration have evolved. Two such variations include intensity-modulated radiotherapy and 3D conformational radiotherapy. These modalities have been investigated for their efficacy and rate of adverse events. However, conclusions from the trials conducted have been variable. In this systematic review and meta-analysis, we aim to collate these findings to assess the exposure of cancerous cells and rates of adverse events following IMRT or 3D-CRT. Methods: A comprehensive literature search was conducted across three databases for all articles published from inception till September 2024. All primary studies evaluating the comparative efficacy of IMRT vs 3D-CRT were included. Outcomes assessed include dose volume histograms (DVHs) at heart and lung, Dmax at the spinal cord, and irradiation toxicity. Data analysis was conducted in RevMan 5.4 using a random-effects model. Results: A total of twenty records were included in the study, with a sample size of 3090 patients. Radiation dosage, estimated as DVHs, was equal across both regimens at heart (MD: 2.67; 95%CI: –0.15 to 5.48; P = 0.06), except at 40 Gy of radiation, where a lower DVH was noted among patients being administered IMRT (MD: 6.64; 95%CI: 0.25 to 13.03; P = 0.04). At the lung, a higher DVH was noted, especially for doses of 20 Gy or above, on using IMRT. Similarly, a lower dosage in the spinal cord was noted in the IMRT group (MD: 2.87; 95%CI: 1.04 to 4.70; P = .002). Consequently, a lower risk of esophagitis was noted among the IMRT group (OR: 1.54; 95%CI: 1.14 to 2.07; p = 0.009]). While considering patient outcomes, the odds of survival were higher in the IMRT group at 3 years post-treatment (OR: 0.53; 95%CI: 0.31 to 0.92; P = 0.02). Conclusions: IMRT was superior to 3D-CRT in terms of volume of tissue irradiated and lower spinal toxicity. A higher chance of survival was noted in the IMRT group. Further trials are needed to strengthen these findings. Outcome Mean Difference (MD) 95% confidence interval (CI) P value Mean dosage at lung 1.14 0.6, 1.68 <0.0001 Mean dosage at heart 2.67 -0.15, 5.48 0.06 Radiation esophagitis Odds ratio, OR: 1.38 1.09, 1.76 0.009 Radiation pneumonitis OR:1.37 0.62, 3.01 0.43 3-year OS OR: 0.69 0.56, 0.84 0.0003 5-year OS OR: 0.53 0.31, 0.92 0.02 Maximum dosage at spinal cord 2.87 1.04, 4.7 0.0002

e16237 Background: Alcohol use (AU) and Liver cell carcinoma (LCC) are significant contributors to adult mortality worldwide. Examining trends and disparities in AU and LCC-related deaths is essential for understanding public health challenges and formulating targeted interventions. This study investigates national mortality patterns related to AU and LCC in the United States from 1999 to 2023, emphasizing demographic, geographic, and temporal disparities. Methods: This descriptive analysis used the CDC WONDER database (1999–2023) to identify AU-related deaths (ICD-10 codes E24.4, F10, G32.2, G62.1, G72.1, I42.6, K70, K85.2, K86.0, R78.0, T51, X65, Y15) and LCC (ICD-10 code C22.0) in adults aged 25 and older. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals were calculated, stratified by gender, race/ethnicity, census region, urban-rural classification, and state. Trends were analyzed using Joinpoint regression to compute annual percent changes (APCs) and 95% confidence intervals (CIs). Statistical significance was set at p < 0.05, and analyses adhered to STROBE guidelines. Results: From 1999 to 2023, a total of 21,007 deaths were attributed to LCC and AU (Men: 18,836 Women: 2,171). AAMRs showed a stable trend from 1999 to 2003 (APC: 0.0; 95% CI: -8.7 to 4.9) but increased significantly from 2003 to 2019 (APC: 6.1; 95% CI: 5.7 to 7.4), stabilizing from 2019 to 2023 (APC: -0.6; 95% CI: -3.2 to 1.3). Men's AAMRs decreased from 1999 to 2003 (APC: -1.1; 95% CI: -10.4 to 3.4), then rose sharply from 2003 to 2019 (APC: 6.1; 95% CI: 5.6 to 7.1). For women, AAMRs increased significantly, particularly between 2013 and 2017 (APC: 12.4; 95% CI: -9.5 to 25.1). Non-Hispanic Black and White populations experienced notable increases in AAMRs, while Hispanic people showed an initial decline followed by an increase post-2004 (APC: 4.7; 95% CI: 3.7 to 7.9). The West had the highest regional AAMR (5.3; 95% CI: 5.2 to 5.5), while the Northeast recorded the lowest (2.1; 95% CI: 2.0 to 2.2). New Mexico had the highest state AAMR (8.4; 95% CI: 7.4 to 9.4), and Mississippi the lowest (1.2; 95% CI: 0.9 to 1.5). AAMRs rose more sharply in non-metropolitan areas from 1999-2020 (APC: 6.6; 95% CI: 5.9 to 7.8) compared to metropolitan regions from 2004 to 2020 (APC: 5.4; 95% CI: 4.9 to 6.5). Conclusions: AU and LCC-related mortality rates have increased significantly since 2003, with distinct gender, racial, and geographic disparities. Men and rural populations faced higher mortality increases, with notable variations across states and regions. These findings underscore the need for focused public health efforts to mitigate these disparities and address the growing burden of LCC and AU-related mortality.