Trends in mortality among older adults with coexisting ischemic heart disease and thoracic malignancies: A 25-year analysis of U.S. national data.

e24029 Background: Ischemic heart disease (IHD) and thoracic malignancies are leading causes of death in older adults, often coexisting due to shared risk factors such as smoking and aging. This study aimed to assess national mortality trends from 1999–2023 among adults aged ≥55 with both IHD and thoracic cancers, stratified by key demographic variables using the CDC WONDER database. Methods: We conducted a retrospective cohort study using CDC WONDER data (1999–2023) on U.S. adults aged ≥55 years. Eligible deaths listed ischemic heart disease (ICD-10: I20–I25) as the underlying cause and thoracic neoplasms (ICD-10: C33, C34, C38) as contributing causes. Age-adjusted mortality rates per 100,000 were calculated and stratified by year and sex. Joinpoint regression analysis identified temporal trends using annual percent change with 95% confidence intervals. Results: Over 24 years, age-adjusted mortality rates (AAMRs) for ischemic heart disease with thoracic neoplasms declined significantly from 1999–2016 (APC: –5.49; 95% CI: –7.32 to –3.54; p < 0.001), though disparities persisted. Males accounted for 65.15% of deaths versus 34.85% in females. Non-Hispanic Whites bore the highest burden (88.11% of deaths), and the Southern region exhibited elevated mortality (7.45%). Urban areas showed steeper AAMR declines (Large Central Metro APC: –5.94; p < 0.001) than rural settings. Notably, Pacific Islanders experienced increasing mortality post-2017 (APC: +14.16; p < 0.001). State-level variations were pronounced, with West Virginia's AAMR (5.1) nearly triple that of Wyoming (1.7). Despite overall improvement, findings reveal ongoing geographic and racial disparities, emphasizing the need for equity-focused interventions. Conclusions: From 1999–2023, mortality from IHD and thoracic neoplasms declined overall, with sharper decreases in males, Whites, and metropolitan areas. However, recent years showed plateauing in females and Hispanics, and rising trends in Pacific Islanders. Regional and urban–rural disparities persist, highlighting the need for focused public health action.