Uncovering the mortality burden of lung cancer with documented sleep apnea in the United States: a 22-year population-based study
4 affiliations
- 1Department of Nursing, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital) , ,
- 2Department of Respiratory and Critical Care, Guangyuan Central Hospital , ,
- 3School of Clinical Medicine, Chengdu Medical College , ,
- 4Department of Respiratory and Critical Care Medicine, Deyang People’s Hospital, Affiliated Hospital of Chengdu Medical College , ,
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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BibTeX
@article{lin2026uncovering,
title = {{Uncovering the mortality burden of lung cancer with documented sleep apnea in the United States: a 22-year population-based study}},
author = {Lan Lin and Ping Shi and Qingyuan Li and Tong Feng and Ran Duan and Pengcheng Zheng},
journal = {Frontiers in public health},
year = {2026},
month = sep,
doi = {10.3389/fpubh.2026.1925388},
url = {https://europepmc.org/article/PMC/PMC13661379},
note = {CC BY},
}
RIS
TY - JOUR
TI - Uncovering the mortality burden of lung cancer with documented sleep apnea in the United States: a 22-year population-based study
AU - Lan Lin
AU - Ping Shi
AU - Qingyuan Li
AU - Tong Feng
AU - Ran Duan
AU - Pengcheng Zheng
PY - 2026
DA - 2026/09/30
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1925388
UR - https://europepmc.org/article/PMC/PMC13661379
AB - 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.
SN - 2296-2565
ER -