Trends and Inequalities in mortality from ischemic heart disease in adult patients with colorectal cancer: A population-based retrospective study in the United States from 1999 to 2020

Trends and Inequalities in mortality from ischemic heart disease in adult patients with colorectal cancer: A population-based retrospective study in the United States from 1999 to 2020 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends and Inequalities in mortality from ischemic heart disease in adult patients with colorectal cancer: A population-based retrospective study in the United States from 1999 to 2020 Zeyu Tu, Shumin Zhang, Xiao Huang, Peipei Yang, Wenxuan Wu, Yanan Luo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8530955/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Ischemic heart disease (IHD) ranks as one of the primary causes of non-cancer mortality in patients with colorectal cancer (CRC). However, population studies examining long-term mortality trends and disparities among various adult populations in the United States remain relatively scarce. Methods This study employed death certificate data from the CDC WONDER spanning 1999 to 2020 to identify adult patients (≥ 25 years old) in the United States who died from colorectal cancer (CRC; ICD-10: C18-C20) as the primary cause of death due to ischemic heart disease (IHD; ICD-10: I20-I25). Age-adjusted mortality rates (AAMRs) and annual percentage changes (APCs) were calculated, and stratified analyses were performed based on gender, age, race, and geographical location. Results Consensus identified 43,395 cases of IHD-related deaths among CRC patients. From 1999 to 2020, the overall AAMR exhibited a significant downward trend, with an average annual percentage change (AAPC) of -8.26 from 2002 to 2016 (p < 0.001), and it appeared to stabilize after 2016. Subgroup analysis indicated notable population differences: the AAMR in men consistently surpassed that in women. The AAMR was highest among the elderly population (aged 65 and above) at 4.36, while it was lower in the middle-aged group at 0.18. In terms of racial and ethnic stratification, non-Hispanic blacks/African Americans recorded the highest AAMR at 0.98. Additionally, the AAMR in the northeastern region was 1.24, exceeding that of other regions. Furthermore, the AAMR in non-urban areas was 0.994, which was higher than the 0.896 observed in urban areas. Conclusion Despite a decline in the overall mortality rate associated with IHD among CRC patients over the past 20 years, notable disparities persist across gender, age, race/ethnicity, and geographical location. These observations underscore the necessity for targeted public health interventions and the strategic allocation of medical resources to mitigate these health inequalities. Special emphasis should be placed on high-risk populations, including men, the elderly, non-Hispanic blacks/African Americans, and individuals residing in rural areas. Colorectal cancer Ischemic heart disease Mortality Gender disparity Racial disparity Epidemiology Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarydata.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor assigned by journal 11 Jan, 2026 Submission checks completed at journal 08 Jan, 2026 First submitted to journal 06 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8530955","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607218052,"identity":"431ac5ce-5fac-4ac2-98b4-6ed5936554b4","order_by":0,"name":"Zeyu Tu","email":"","orcid":"","institution":"Jiangsu Provincial Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zeyu","middleName":"","lastName":"Tu","suffix":""},{"id":607218053,"identity":"8e65e5c6-6e89-45e8-aa4c-b1295e193a4b","order_by":1,"name":"Shumin Zhang","email":"","orcid":"","institution":"Jiangsu Provincial Hospital of Traditional 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2020","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colorectal cancer, Ischemic heart disease, Mortality, Gender disparity, Racial disparity, Epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-8530955/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8530955/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIschemic heart disease (IHD) ranks as one of the primary causes of non-cancer mortality in patients with colorectal cancer (CRC). However, population studies examining long-term mortality trends and disparities among various adult populations in the United States remain relatively scarce.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study employed death certificate data from the CDC WONDER spanning 1999 to 2020 to identify adult patients (\u0026ge;\u0026thinsp;25 years old) in the United States who died from colorectal cancer (CRC; ICD-10: C18-C20) as the primary cause of death due to ischemic heart disease (IHD; ICD-10: I20-I25). Age-adjusted mortality rates (AAMRs) and annual percentage changes (APCs) were calculated, and stratified analyses were performed based on gender, age, race, and geographical location.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eConsensus identified 43,395 cases of IHD-related deaths among CRC patients. From 1999 to 2020, the overall AAMR exhibited a significant downward trend, with an average annual percentage change (AAPC) of -8.26 from 2002 to 2016 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and it appeared to stabilize after 2016. Subgroup analysis indicated notable population differences: the AAMR in men consistently surpassed that in women. The AAMR was highest among the elderly population (aged 65 and above) at 4.36, while it was lower in the middle-aged group at 0.18. In terms of racial and ethnic stratification, non-Hispanic blacks/African Americans recorded the highest AAMR at 0.98. Additionally, the AAMR in the northeastern region was 1.24, exceeding that of other regions. Furthermore, the AAMR in non-urban areas was 0.994, which was higher than the 0.896 observed in urban areas.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite a decline in the overall mortality rate associated with IHD among CRC patients over the past 20 years, notable disparities persist across gender, age, race/ethnicity, and geographical location. These observations underscore the necessity for targeted public health interventions and the strategic allocation of medical resources to mitigate these health inequalities. Special emphasis should be placed on high-risk populations, including men, the elderly, non-Hispanic blacks/African Americans, and individuals residing in rural areas.\u003c/p\u003e","manuscriptTitle":"Trends and Inequalities in mortality from ischemic heart disease in adult patients with colorectal cancer: A population-based retrospective study in the United States from 1999 to 2020","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 23:22:44","doi":"10.21203/rs.3.rs-8530955/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-19T12:35:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243999507614683692394800835653281807395","date":"2026-03-16T23:59:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-16T22:28:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-11T16:58:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-08T12:32:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cardio-Oncology","date":"2026-01-06T11:42:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cardio-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caon","sideBox":"Learn more about [Cardio-Oncology](http://cardiooncologyjournal.biomedcentral.com)","snPcode":"40959","submissionUrl":"https://submission.nature.com/new-submission/40959/3","title":"Cardio-Oncology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3e8dfa0-0176-4a15-8467-87781b073fd6","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-18T23:22:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 23:22:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8530955","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8530955","identity":"rs-8530955","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}