Abstract
BACKGROUND: Recent data report individuals with colorectal cancer (CRC) to be 2 to 4 times more likely to develop cardiovascular disease (CVD), while established CVD risk factors are linked with an elevated risk of CRC. This study aimed to evaluate national trends in combined CRC and CVD mortality in the United States and assess variations by demographic and geographic characteristics. METHODS: Combined mortality-related deaths in the United States were extracted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). The Multiple Cause-of-Death Public Use record death certificates were studied to identify records in which both CRC and CVD were mentioned as either contributing or underlying causes of death on nationwide death certificates. RESULTS: Between 1999 and 2019, a total of 1,303,016 CRC-related deaths occurred in individuals aged ≥25 years, of which 394,871 (31.8%) deaths also noted CVD. The overall CRC+CVD-related age-adjusted mortality rate per 100 000 declined from 12.06 in 1999 to 6.69 in 2019. The age-adjusted mortality rates were higher in men (11.1) versus women (7.2). Among young adults aged 35 to 44 years, the crude mortality rates increased annually by 1.8% from 1999 to 2019. The age-adjusted mortality rates were highest for non-Hispanic Black or African American individuals and lowest for non-Hispanic Asian or Pacific Island people (12.22 versus 6.19). The rates were higher in nonmetropolitan (9.77) than metropolitan (8.58) counties and varied by region, being highest in the Northeast (10.6), followed by the West (9.0), Midwest (8.4), and South (7.9). CONCLUSIONS: Nearly one-third of CRC-related deaths also involved CVD. Although combined mortality has declined overall, it remains disproportionately high among men, Black or African American individuals, and rural populations. Notably, mortality is increasing among adults aged 35 to 44 years, highlighting persistent disparities and the urgent need for integrated cardiometabolic prevention strategies in patients with cancer.