Venous thromboembolism mortality trends among us adults with cancer, 1999-2024

Venous thromboembolism (VTE) remains a leading preventable cause of death among cancer patients in the United States. Despite advances in thromboprophylaxis and clinical guideline development, nationally representative longitudinal data on VTE-related mortality trends in this population remain limited. Using CDC WONDER multiple-cause-of-death records (1999-2024), we identified VTE-related deaths (ICD-10: I26, I80-I82) among US adults aged ≥ 25 years with a concurrent cancer diagnosis (C00-C97). Age-adjusted mortality rates (AAMRs) per 100,000 persons and average annual percent changes (AAPCs) with 95% confidence intervals were estimated using Joinpoint regression and stratified by sex, race/ethnicity, age group, urbanization level, Census region, and state. Among 312,260 VTE-related cancer deaths, the national AAMR rose from 3.92 to 7.58 per 100,000 (AAPC: 2.40%; p < 0.001), with the sharpest acceleration during 2019-2022 (APC: 12.78%; p = 0.031). Increases were statistically significant across all demographic and geographic subgroups, though the magnitude varied considerably. By sex, mortality rose more steeply among women (AAPC: 2.61%; p < 0.001) than men (AAPC: 2.14%; p < 0.001). By race/ethnicity, the fastest increases occurred among non-Hispanic American Indian/Alaska Native (3.73%; p < 0.001), non-Hispanic Asian/Pacific Islander (3.62%; p < 0.001), Hispanic (3.12%; p < 0.001), and non-Hispanic Black (3.07%; p < 0.001) populations, compared with non-Hispanic White individuals, who showed the slowest rise (2.45%; p < 0.001). By age group, AAPCs ranged from 2.09% among adults 55-64 years (p < 0.001) to 4.19% among those ≥ 85 years (p < 0.001), indicating a disproportionate burden among the oldest patients. By Census region, the West (3.02%; p < 0.001) and South (2.70%; p < 0.001) exhibited faster growth than the Midwest (2.33%; p < 0.001) and Northeast (2.13%; p < 0.001). At the state level, AAPCs ranged from - 2.76% in Maine (p = 0.034), the only state with a significant decline, to 6.15% in Colorado (p < 0.001), with 39 of 51 jurisdictions showing statistically significant increases. VTE-related mortality among US adults nearly doubled from 1999 to 2024. A marked surge was observed during the COVID-19 pandemic, followed by stabilization after 2022. Persistent disparities across demographic and geographic subgroups underscore the urgent need for equity-oriented prevention strategies.