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Background <p>The COVID-19 pandemic coincided with substantial disruptions to cancer care services worldwide. However, comprehensive population-level assessments of deviations from expected lung cancer mortality trends during the pandemic period using rigorous counterfactual methods remain limited, particularly regarding heterogeneity across demographic and geographic subgroups.</p> Methods <p>We performed a counterfactual analysis examining lung cancer mortality trends among United States adults aged 45 years and older (1999–2023) using CDC WONDER mortality data. Joinpoint regression characterized pre-pandemic trends (1999–2019) to project expected mortality rates for 2020–2023. Mortality gaps were calculated as differences between observed and expected age-adjusted rates across 66 demographic and geographic strata. Interrupted time series analysis evaluated pandemic-associated trend modifications. Population-weighted linear regression assessed dose-response relationships between state-level COVID-19 burden and lung cancer excess mortality.</p> Results <p>National age-adjusted lung cancer mortality rates declined from 156.03 per 100,000 in 1999 to 94.90 in 2019 (annual percent change: -4.56, 95% CI: -4.92 to -4.20). During the pandemic period, cumulative excess lung cancer mortality totaled 11.26 per 100,000, with statistically significant positive gaps emerging in 2021 (+ 3.67), 2022 (+ 2.77), and 2023 (+ 4.99). Non-Hispanic White populations exhibited three-fold greater 2023 lung cancer excess (+ 6.21) compared to Hispanic populations (+ 1.81). Age-stratified analysis revealed sixteen-fold gradients in lung cancer mortality gaps, from + 1.53 per 100,000 in the 45–54 years cohort to + 24.75 in those aged 85 years and older. State-level cumulative lung cancer mortality gaps ranged from − 40.72 to + 63.16 per 100,000. A significant positive ecological association was observed between state-level cumulative COVID-19 mortality and cumulative lung cancer mortality gaps (β = 0.056, 95% CI: 0.010–0.103, <i>P</i> = 0.022).</p> Conclusions <p>The COVID-19 pandemic was associated with deviations from expected lung cancer mortality trends, exhibiting substantial demographic and geographic heterogeneity. These patterns may reflect differences in healthcare system capacity across populations. Population-specific surveillance systems and infrastructure investments warrant consideration to maintain cancer care continuity during future public health emergencies.</p>

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Deviations from pre-pandemic lung cancer mortality trends in the United States: a 25-year counterfactual analysis (1999–2023)

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  • 发表日期：

    2026年2月2日

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  • Sichang Wang

摘要

Background

The COVID-19 pandemic coincided with substantial disruptions to cancer care services worldwide. However, comprehensive population-level assessments of deviations from expected lung cancer mortality trends during the pandemic period using rigorous counterfactual methods remain limited, particularly regarding heterogeneity across demographic and geographic subgroups.

Methods

We performed a counterfactual analysis examining lung cancer mortality trends among United States adults aged 45 years and older (1999–2023) using CDC WONDER mortality data. Joinpoint regression characterized pre-pandemic trends (1999–2019) to project expected mortality rates for 2020–2023. Mortality gaps were calculated as differences between observed and expected age-adjusted rates across 66 demographic and geographic strata. Interrupted time series analysis evaluated pandemic-associated trend modifications. Population-weighted linear regression assessed dose-response relationships between state-level COVID-19 burden and lung cancer excess mortality.

Results

National age-adjusted lung cancer mortality rates declined from 156.03 per 100,000 in 1999 to 94.90 in 2019 (annual percent change: -4.56, 95% CI: -4.92 to -4.20). During the pandemic period, cumulative excess lung cancer mortality totaled 11.26 per 100,000, with statistically significant positive gaps emerging in 2021 (+ 3.67), 2022 (+ 2.77), and 2023 (+ 4.99). Non-Hispanic White populations exhibited three-fold greater 2023 lung cancer excess (+ 6.21) compared to Hispanic populations (+ 1.81). Age-stratified analysis revealed sixteen-fold gradients in lung cancer mortality gaps, from + 1.53 per 100,000 in the 45–54 years cohort to + 24.75 in those aged 85 years and older. State-level cumulative lung cancer mortality gaps ranged from − 40.72 to + 63.16 per 100,000. A significant positive ecological association was observed between state-level cumulative COVID-19 mortality and cumulative lung cancer mortality gaps (β = 0.056, 95% CI: 0.010–0.103, P = 0.022).

Conclusions

The COVID-19 pandemic was associated with deviations from expected lung cancer mortality trends, exhibiting substantial demographic and geographic heterogeneity. These patterns may reflect differences in healthcare system capacity across populations. Population-specific surveillance systems and infrastructure investments warrant consideration to maintain cancer care continuity during future public health emergencies.