Abstract
Thyroid cancer mortality has varied across demographic groups in the US, but recent comprehensive analyses are limited, especially those that account for Covid-19. This study examines trends in thyroid cancer-related mortality from 1999 to 2023 using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. The endpoints of this study are trends in mortality by: sex (female, male), urbanization (rural, urban), race, and ten-year age groups from 1999 to 2023.
Trends in mortality from malignant thyroid neoplasms (ICD-10: C73) were analyzed, examining for age-adjusted mortality rates (AAMR) and annual percent change (APC) across sex, age, race, and urbanization using Joinpoint regression programing. Joinpoint regression programming identifies statistically significant changes in data trend by fitting a series of joined log-linear segments. Statistical significance is defined as p<0.05 (*).
There were 53,145 deaths. Overall, the AAMR declined from 0.86 to 0.77 per 100,000. Mortality trends rose for females and males until 2019 and 2020 (APC: 0.7* [0.3486 to 1.1155] and 1.1* [0.8274 to 1.5453] respectively) and then fell until 2023 (APC: -8.6* [-12.931 to -5.592] and -12* [-23.054 to -7.1893] respectively). Rural mortality increases exceeded urban (APC: 1.3* [0.9582 to 1.7976] vs 0.8* [0.6096 to 1.1017] respectively). Black and White patients experienced consistently lower mortality than Asian or Pacific Islander (API) and Hispanic patients. However, Hispanic and White patients experienced an overall increase in mortality (APC: 0.6* [0.0863 to 1.2012] and 1.2* [0.9964 to 1.3645] respectively). Black or African American and API experienced insignificant changes in yearly mortality. Thyroid cancer AAMR rose with age, with the steepest increases in the oldest groups. The 85+ cohort experienced an insignificant rise in mortality from 1999–2017 (APC 1.30; [–1.66-1.94]). They then experienced a significant increase from 2017–2023 (APC 4.51*; [2.22-11.46]). The age groups of 75–84 and 65–74 showed significant increases across the period (APC 1.1* [0.85–1.42] and 0.6* [0.28–1.02], respectively).
Overall thyroid cancer mortality fell, yet trends differed by group. Males and females experienced significant decreases in mortality post 2019/2020, yet older adults, rural residents and White/Hispanic populations experienced significant increases in mortality. Healthcare systems and policy makers should be aware of these disparities when caring for disadvantaged populations. Future research should try to better elucidate the reasons behind these trends, including examining variables such as stage and treatment patterns, and comparing them between demographic groups.