Presentation Authors: Parth Thakker*, Jyoti Chouhan, Ethan Matz, Amy Pearlman, Marc Colaco, James Lovato, Ryan Terlecki, Winston-Salem, NC
Introduction: Disease intervention is predicated on probability of morbidity and/or mortality, considering expected longevity and competing causes of death. While cardiovascular disease (CVD) remains the most common cause of death for all Americans, rates are decreasing. As death relative to CVD decreases, rates attributed to other causes increase with relevance to screening, counseling, and decision-making. We sought to determine the domestic trend in death secondary to genitourinary malignancy (GUm) relative to CVD as an index (GUm/CVDi).
Methods: The CUDA study is a comprehensive review of all-cause mortality data from death records warehoused by the CDC from 2005-2016, encompassing 2.3-2.7 millions deaths per year. To our knowledge, this is the first study to do so relative to urologic disease. Subset analysis was performed of deaths attributed to GUm and CVD using relevant ICD-10 codes and a time series regression analysis was performed. Rates were compared to determine the GUm/CVDi.
Results: Over the study interval, percentage of male deaths attributed to prostate (PC) and renal cancer (RC) fell from 2.6% to 2.3%, and 0.681% to 0.675%, respectively. Those due to bladder cancer (BC) increased from 0.811% to 0.904%. In women, those due to RC decreased from 0.390% to 0.368%, whereas BC deaths increased from 0.337% to 0.360%. CVD deaths decreased from 29.02% to 26.11% in men, and from 27.25% to 22.57% in women. GUm/CVDi increased from 0.053 to 0.062 in men and from 0.027 to 0.032 in women. The GUm/CVDi is rising at a greater rate for men (R2=0.756, p < 0.01, F= 35.1) than for women (0.801, p < 0.01, 45.4). All reported trends were statistically significant.
Conclusions: Relative to competing causes, death secondary to PC and RC has decreased over the past decade in the U.S. while BC mortality has risen. Concurrently, mortality from CVD has decreased. Thus, while mortality trends for a given GUm may suggest issues relevant to the disease itself and/or oncologic therapy, they may be due, in part, to progress made in competing causes of death. The differences in slope of the GUm/CVDi curves between genders is likely due to lower death rates from CVD for women compared to men at study onset. Although further study is warranted, this data is relevant for patient counseling.