Trends in Septicemia- and Influenza/Pneumonia-Related Mortality Among Patients With Malignant Neoplasms: A Nationwide...

Infectious complications remain a major cause of morbidity and mortality among patients with malignant neoplasms despite advances in cancer treatment and supportive care. However, nationwide evidence on long-term trends and demographic and geographic disparities in infection-related mortality remains limited. This study aimed to evaluate the burden and temporal trends of septicemia- and influenza/pneumonia-related mortality among patients with malignant neoplasms in the United States and to examine demographic and geographic disparities and population-level predictors of infection-related mortality.

The study was conducted using a population-based ecological design with the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death Database. Deaths from 1999 to 2020 were selected based on a malignant neoplasm as the underlying cause of death and septicemia and/or influenza and pneumonia as other causes of death. The mortality burden was estimated using annual deaths and adjusted mortality rates. Time trend analysis was performed using Joinpoint regression. Demographic and geographic differences were explored with the Mann-Whitney U test, Kruskal-Wallis test, and multivariable negative binomial regression analysis.

The overall mortality associated with infections had a significant reduction during the study period (Average Annual Percent Change -1.87%; 95% confidence interval -2.04 to -1.71; p < 0.001), but the rate of reduction decreased after 2012. Infections such as septicemia were responsible for a higher mortality burden and experienced a slight reduction (Average Annual Percent Change -0.38%), while influenza and pneumonia had a rapid decline in mortality (Average Annual Percent Change -3.05%). The infections led to a higher mortality rate among older adults, males, Black or African Americans, and people living in nonmetropolitan areas. Multivariable analysis identified race, male sex, and rural urbanisation as independent predictors of infection-related mortality.

Despite substantial reductions in infection-related mortality over two decades, septicemia remains a persistent cause of death among patients with malignant neoplasms. Persistent demographic and geographic disparities highlight the need to strengthen infection prevention, vaccination, antimicrobial stewardship, early sepsis recognition, and equitable supportive oncology care.