ArticleFrontiers in public health2026
Uncovering the mortality burden of lung cancer with documented sleep apnea in the United States: a 22-year population-based study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Background: Lung cancer remains the leading cause of cancer-related mortality worldwide, and sleep apnea may identify a clinically vulnerable subgroup of patients with lung cancer. However, population-level mortality patterns involving lung cancer with documented sleep apnea remain unclear. This study examined long-term trends, disparities, geographic variation, socioeconomic patterns, and future projections of related mortality in the United States. Methods: We conducted a retrospective population-based analysis using CDC WONDER Multiple Cause of Death data from 1999 to 2020. Deaths were included when lung cancer was recorded as the underlying cause of death and sleep apnea as a contributing cause. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Temporal trends were assessed using Joinpoint regression, historical AAMRs were projected with ARIMA models, out-of-sample performance was evaluated against final 2021-2024 CDC WONDER data, and state-level Sociodemographic Index and frontier analyses were performed. Results: A total of 4,339 deaths involving lung cancer with documented sleep apnea were identified. The overall AAMR was 0.05 per 100,000 population. Mortality was concentrated predominantly among adults aged 65 years and older and was higher among men, White and non-Hispanic individuals, residents of nonmetropolitan areas, and those living in the Midwest and West. The AAMR increased from 0.011 in 1999 to 0.112 in 2020, with a significant annual percent change of 9.398%. The ARIMA model projected an increase to 0.160 per 100,000 by 2030, but it consistently overestimated observed AAMRs during 2021-2024 (MAPE 9.71%); therefore, these forecasts were interpreted as conditional and exploratory projections. State-level analyses showed marked geographic heterogeneity not fully explained by socioeconomic development. Conclusion: Mortality involving lung cancer and documented sleep apnea increased substantially over 22 years and showed clear demographic and geographic disparities, with a disproportionate burden among older adults, particularly those aged 65 years and above. The historical trend and exploratory forecasting results support continued attention to sleep health assessment and integrated respiratory-oncology care.
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