Tobacco use–driven lung cancer mortality in the United States: A population-based analysis from 2003 to 2023.

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e20039 Background: Lung cancer (LC) is the leading cause of cancer death worldwide, with tobacco use as its primary risk factor. Despite advances in detection and treatment, smoking-related disease continues to impose a heavy burden. This study examines LC mortality disparities, trends, and geographic variation among tobacco users in the United States from 2003 to 2023. Methods: Using the CDC WONDER database for adults aged ≥25, we analyzed age-adjusted and crude mortality rates (AAMRs and CMRs) per 100,000 for LC (ICD-10: C34) among patients with tobacco use (ICD-10: F17) by year, sex, race/ethnicity, and geography. Joinpoint regression estimated average annual percentage change (AAPC) and annual percentage change (APC) with 95% confidence interval (CIs). Results: During the study, an overall burden of 3,148,638 deaths was observed due to LC, among which 1,222,199 cases were attributed to tobacco use as a contributory cause, most occurring at the Decedent's home. The overall AAMR rose from 12.79 in 2003 to 19.25 in 2023 (AAPC: 1.94%; p<0.001), with significant increases in 2003–2005 (APC: 34.15, 95% CI: 22.16 to 47.32) and notable recent declines in 2016–2023 (APC: -4.97, 95% CI: -5.79 to -4.15). Men consistently had higher AAMR than women, nearly double in 2003 (17.33 vs. 9.50), and the disparity persisted in 2023 (23.19 vs. 16.00). Non-Hispanic (NH) Whites had the highest AAMR, rising 2.49% annually (p<0.001), while NH Asians or Pacific islanders had the lowest with a 1.92% annual increase (p=0.05). Regionally, the Midwest experienced the fastest rise in AAMR at 4% annually (p<0.001), while the West had the lowest AAMR. Mortality in rural areas (AAMR 34.14) rose rapidly (4.37%; p<0.001) than in urban populations (23.75; 2.93%). Vermont and Oregon ranked highest in the top 90th percentile. Conclusions: Tobacco use-driven LC mortality has risen overall, with declines in more recent years. However, disparities in outcomes remain prevalent, underscoring the urgent need for health service initiatives, including tobacco cessation education, lung cancer screening, and telehealth platforms, to improve access to care for affected populations. Deaths and AAPC for trends related to LC among tobacco users from 2003 to 2023. Variable Deaths AAPC (2003-2023) with CI Overall 1,222,199 1.95 (0.89 to 3.01) Male 695,442 1.40 (0.38 to 2.43) Female 526,757 2.46 (1.05 to 4.00) NH White 1,064,773 2.46 (1.37 to 3.56) NH Black 10,8178 1.56 (-0.29 to 3.43) NH American Indian or Alaska Native 7,175 0.68 (-2.10 to 3.53) Hispanic 29,258 -1.34 (-2.71 to 0.04) NH Asians 12,815 1.93 (-0.08 to 3.97) Midwest 371,508 4.01 (1.86 to 6.21) West 163,612 -0.52 (-1.70 to 0.67) South 450,020 1.43 (0.48 to 2.40) Northeast 237,059 1.33 (-0.16 to 2.85)

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