2807 - Trends in Circulatory Comorbidity among Young Americans Dying of Malignant Neoplasms: A National Population-Based Analysis, 2018-2024

Purpose/Objective(s):

Cardiotoxicity from radiation and systemic cancer therapy contributes substantially to long-term morbidity in young patients. Understanding the prevalence and trajectory of circulatory comorbidity at time of death may inform cardioprotective treatment strategies and risk stratification in radiation oncology. We characterized national trends in circulatory disease comorbidity among malignant neoplasm deaths in Americans aged 0–39 years, with a priori stratification into pediatric (0–14) and young adult (15–39) cohorts.

Materials/Methods:

The CDC WONDER Multiple Cause of Death database (2018–2024) was queried for deaths with underlying cause ICD-10 C00–C97 (malignant neoplasms) in persons aged 0–39. Circulatory comorbidity was defined by any concurrent ICD-10 I00–I99 code listed as a contributing cause of death. Annual crude death rates per 100,000 and proportions with circulatory comorbidity were calculated by year, age group, race, and sex. Poisson generalized linear models (GLM) with log-population offset estimated annual percentage change (APC) in death rates; binomial GLM with logit link estimated APC in cardiac comorbidity proportion. Logistic joinpoint regression ({ljr}) assessed for temporal changepoints.

Results:

Among 73,636 malignant neoplasm deaths in ages 0–39 (2018–2024), 12,637 (17.2%) had a concurrent circulatory comorbidity. Among pediatric decedents (0–14 years; n=8,389), 13.3% had circulatory comorbidity with no significant temporal trend (APC +0.71%/year; p=0.66) and stable crude death rates (APC -0.29%/year; p=0.59). Among young adult decedents (15–39 years; n=65,247), the proportion with circulatory comorbidity rose significantly from 16.7% (2018) to 18.8% (2024) (APC +2.21%/year; p<0.001), despite a modestly declining overall cancer death rate (APC -0.52%/year; p=0.007). Black/African American young adults carried the highest cancer mortality rate (9.9 per 100,000) and the highest cardiac comorbidity proportion (20.5%), compared to White (8.6/100,000; 17.7%) and Asian (6.1/100,000; 15.4%) patients.

Conclusion:

Circulatory comorbidity is documented in approximately 1 in 6 young cancer decedents and is rising significantly among those aged 15–39 years, with a disproportionate burden in Black/African American patients. These findings have direct implications for radiation oncology: the growing cardiovascular

burden underscores the need for heart-sparing radiation techniques, cardioprotective treatment planning, and systematic post-treatment cardiovascular surveillance, particularly in young adult and minority populations.