Trends in lung cancer and pneumonia-associated mortality in the United States, 1999-2023: A CDC WONDER database study.

Background: Lung cancer (LC) and pneumonia remain leading causes of mortality in the United States, with particularly severe impacts on vulnerable populations. While LC continues to be the deadliest cancer, pneumonia poses a critical threat to immunocompromised individuals, especially those with LC. This study examines 24-year trends in LC and pneumonia-related deaths, analyzing disparities across demographic groups and geographic regions to inform targeted public health strategies. Methods: We analyzed mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (1999-2023), calculating age-adjusted mortality rates (AAMRs) per 100 000 population. The study population included adults aged 25 + with LC and pneumonia listed as underlying or contributing causes of death. Joinpoint regression identified significant trends in mortality rates, stratified by sex, race/ethnicity, urbanization level, and US census region. Results: The analysis revealed a 51% decline in LC and pneumonia-related mortality over 24 years, with AAMRs dropping from 53.1 to 25.9 deaths per 100 000. The most dramatic improvement occurred between 2006 and 2009, when mortality rates fell by nearly 10% annually - likely reflecting advances in targeted cancer therapies, expanded screening programs, and stronger vaccination efforts. Despite overall progress, significant disparities persisted. Men died at twice the rate of women throughout the study period, with 2023 AAMRs of 32.6 for males versus 20.1 for females. Racial gaps remained troubling, as Black Americans consistently faced the highest mortality rates (65.7 in 1999 vs 30.7 in 2023), while Asian/Pacific Islanders saw an unexpected 10% mortality increase post-2021. Geographically, rural areas had 31% higher death rates than urban centers, and Southern states carried the heaviest burden across all regions. Conclusions: While national mortality trends show encouraging declines - particularly after 2006 - persistent disparities by sex, race, and geography highlight unmet public health needs. The findings call for tailored interventions addressing higher-risk groups, including enhanced screening in rural areas, culturally competent care for racial/ethnic minorities, and continued smoking cessation support. Sustained progress will require equitable access to emerging treatments and preventive services across all communities.