{
  "abstract": "Background Non-small-cell lung cancer (NSCLC) constitutes approximately 84% of all lung cancer diagnoses and remains a leading cause of cancer mortality globally. 1Immune checkpoint inhibitors (ICIs) have revolutionized treatment and improved clinical outcomes in advanced NSCLC.2 3 Nonetheless, the real-world population-level impact of ICIs on mortality trends, particularly across demographic and geographic strata, remains insufficiently explored.4 5 Methods We conducted a retrospective trend analysis of NSCLC mortality in the United States from 1999 to 2023 using publicly available CDC WONDER data, encompassing adults aged ≥45 years. 6 NSCLC-specific deaths (which accounts for more than 80% of lung cancer diagnosis) were identified using ICD-10 codes C34.0-C34.9. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression modeling was employed to estimate temporal changes and determine annual percent change (APC) with 95% confidence intervals and p-values. Stratifications were conducted by race/ethnicity, sex, U.S. Census regions (Northeast, Midwest, South, West), and urban-rural status, classified by the 2013 NCHS Urban-Rural scheme.7 Sensitivity analyses were performed to assess ICI-era inflection points and subgroup-specific variation.Results From 1999 to 2023, NSCLC-related AAMR declined from 156.03 to 83.73 per 100,000, a 46.3% relative reduction. The steepest decline occurred from 2014–2019 (APC –4.62%, p < 0.001), corresponding with widespread ICI rollout 3 (figure 1). Males consistently exhibited higher mortality than females; however, both sexes experienced marked post-2014 reductions (male APC –5.59%, female APC –4.04%).8 Among racial subgroups, Black/African American individuals saw the largest post-ICI decline (APC –5.16% during 2013–2020) yet still faced higher absolute mortality rates.9 American Indian/Alaska Native populations demonstrated delayed declines, primarily post-2010.10 Geographic disparities emerged, with the West and Northeast regions showing earlier and steeper reductions. Rural populations lagged behind urban centers but began improving significantly after 2011 (APC –2.97%, p < 0.001)11 (table 1).Conclusions Our findings confirm a substantial decline in NSCLC mortality temporally associated with ICI adoption, validating their real-world impact. However, persistent disparities across racial and geographic lines reveal critical gaps in access and delivery. These results support the need for equity-driven strategies, including decentralized screening, diverse trial enrollment, and policy-level efforts to expand immunotherapy access in underserved populations. 9 12 References Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34.Majeed U, Manochakian R, Zhao Y, Lou Y. Targeted therapy in advanced non-small cell lung cancer: current advances and future trends. J Hematol Oncol. 2021;14:108.Goh KY, Teo YN, Tan MH, Lim JCT. Circulating biomarkers for immune checkpoint inhibition in non-small cell lung cancer. Biomedicines. 2023;11(2):508.Liu C, Huang Y, Cui Z, et al. KRAS-mutant non-small cell lung cancer: from molecular heterogeneity to clinical management. Cancer Commun (Lond). 2022;42(9):828–847.Kahlon N, Lakdawala V, Fishbein J, et al. Trends in melanoma mortality in the United States: 2000 to 2019. JAMA Netw Open. 2022;5(12):e2245269.Borghaei H, Gettinger S, Vokes EE, et al. Five-year outcomes from the randomized, phase 3 trials CheckMate 017 and 057. J Clin Oncol. 2021;39(7):723–733.Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK). Lancet. 2017;389(10066):255–265.Socinski MA, Jotte RM, Cappuzzo F, et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378(24):2288–2301.Riaz IB, Islam M, Khan AM, et al. Disparities in representation in immune checkpoint inhibitor trials. Am J Med. 2022;135(8):984–992.e6.Shusted CS, McClellan W, Mirsaeidi M. Racial disparities in lung cancer: analysis of NHIS. JAMA Netw Open. 2021;4(4):e214509.Yang D, Hanna DL, Usher J, et al. Disparities in utilization of immune checkpoint inhibitors in advanced NSCLC. JCO Oncol Pract. 2024;20(2):e2400008.Hsiehchen D, Sharma R, Chatterjee S. Racial disparities in biomarker testing and trial enrollment in lung cancer. J Immunother Cancer. 2021;9(11):e003683.Abstract 1208 Figure 1Age-adjusted NSCLC mortality rates in the United States (1999–2023). Annual age-adjusted mortality rates (AAMR) per 100,000 for non-small cell lung cancer (NSCLC) in U.S. adults aged ≥45 yearsAbstract 1208 Table 1Annual Percent Change (APC) in NSCLC mortality by demographic subgroup (1999–2023). Joinpoint regression analysis showing APC with 95% confidence intervals and p-values, stratified by sex, race/ethnicity, and time periods",
  "authors": [
    {
      "affiliations": [
        "Pakistan Institute of Medical Sciences, Islamabad, Pakistan"
      ],
      "name": "Manzer Ali"
    },
    {
      "affiliations": [
        "Pakistan Institute of Medical Sciences, Islamabad, Pakistan"
      ],
      "name": "Ifra Eeman"
    },
    {
      "affiliations": [
        "Mercyhealth GME Consortium, Rockford, IL, USA"
      ],
      "name": "Saad Rashid"
    },
    {
      "affiliations": [
        "Oncology Program, Moffitt Cancer Center, Tampa, FL, USA"
      ],
      "name": "Mohammed Al-Jumayli"
    },
    {
      "affiliations": [
        "Pakistan Institute of Medical Sciences, Islamabad, Pakistan"
      ],
      "name": "Iqra Iftikhar"
    },
    {
      "affiliations": [
        "Pakistan Institute of Medical Sciences, Islamabad, Pakistan"
      ],
      "name": "Areeba Eeman"
    },
    {
      "affiliations": [
        "Pakistan Institute of Medical Sciences, Islamabad, Pakistan"
      ],
      "name": "Saman Naeem"
    },
    {
      "affiliations": [
        "Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA"
      ],
      "name": "Zeeshan Muzammil"
    },
    {
      "affiliations": [
        "Mercyhealth GME Consortium, Rockford, IL, USA"
      ],
      "name": "Taqi Khaja"
    },
    {
      "affiliations": [
        "Mercy St. Vincent Internal Medicine Residency Program, Toledo, OH, USA"
      ],
      "name": "Sanam Farooq"
    }
  ],
  "title": "1208 Real-world impact of immunotherapy on NSCLC mortality: a stratified joinpoint trend analysis of U.S. data (1999–2023)",
  "uid": "d9a349a9-6aae-5a5f-a39d-b84215e2d8cf"
}