{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:02:02Z","timestamp":1790744522992,"version":"4.1.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20132024 CDC WONDER data, and state-level Sociodemographic Index and frontier analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u202fyears 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\u20132024 (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mortality involving lung cancer and documented sleep apnea increased substantially over 22\u202fyears and showed clear demographic and geographic disparities, with a disproportionate burden among older adults, particularly those aged 65\u202fyears and above. The historical trend and exploratory forecasting results support continued attention to sleep health assessment and integrated respiratory-oncology care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1925388","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:50:55Z","timestamp":1790743855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Uncovering the mortality burden of lung cancer with documented sleep apnea in the United States: a 22-year population-based study"],"prefix":"10.3389","volume":"14","author":[{"given":"Lan","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Nursing, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital)","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care, Guangyuan Central Hospital","place":["Guangyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyuan","family":"Li","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu Medical College","place":["Chengdu, China"]},{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College","place":["Chengdu, China"]},{"name":"Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institute","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Deyang People\u2019s Hospital, Affiliated Hospital of Chengdu Medical College","place":["Deyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Duan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu Medical College","place":["Chengdu, China"]},{"name":"Department of Oncology, The First Affiliated Hospital of Chengdu Medical College","place":["Chengdu, China"]},{"name":"Key Laboratory of Intelligent Medical Care and Elderly Health Management","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengcheng","family":"Zheng","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Chengdu Medical College","place":["Chengdu, China"]},{"name":"Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College","place":["Chengdu, China"]},{"name":"Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institute","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s00408-021-00426-w","article-title":"Evaluation and Management of Adults with obstructive sleep apnea syndrome","volume":"199","author":"Lee","year":"2021","journal-title":"Lung"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"Benjafield","year":"2019","journal-title":"Lancet Respir Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1016\/j.jacc.2016.11.069","article-title":"Sleep apnea: types, mechanisms, and clinical cardiovascular consequences","volume":"69","author":"Javaheri","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"422","DOI":"10.21037\/atm-23-1641","article-title":"Is obstructive sleep apnea a risk factor for lung cancer?-from pathophysiological mechanisms to clinical data","volume":"11","author":"Mart\u00ednez-Garc\u00eda","year":"2023","journal-title":"Ann Transl Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1038\/s41598-020-58906-7","article-title":"Intermittent hypoxia exacerbates tumor progression in a mouse model of lung cancer","volume":"10","author":"Kang","year":"2020","journal-title":"Sci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1513\/AnnalsATS.202108-960OC","article-title":"Obstructive sleep apnea and lung Cancer: a systematic review and Meta-analysis","volume":"19","author":"Cheong","year":"2022","journal-title":"Ann Am Thorac Soc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.sleep.2019.05.011","article-title":"Obstructive sleep apnea and nocturnal hypoxemia are associated with an increased risk of lung cancer","volume":"63","author":"Seijo","year":"2019","journal-title":"Sleep Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2610","DOI":"10.1016\/j.chest.2020.06.055","article-title":"Association Between Nocturnal Hypoxemia and Cancer Incidence in Patients Investigated for OSA: Data From a Large Multicenter French Cohort","volume":"158","author":"Justeau","year":"2020","journal-title":"Chest"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"12394","DOI":"10.1038\/s41598-024-63238-x","article-title":"Association of obstructive sleep apnea with risk of lung cancer: a nationwide cohort study in Korea","volume":"14","author":"Cho","year":"2024","journal-title":"Sci Rep"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/j.sleep.2014.01.020","article-title":"Obstructive sleep apnea is associated with cancer mortality in younger patients","volume":"15","author":"Mart\u00ednez-Garc\u00eda","year":"2014","journal-title":"Sleep Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1091","DOI":"10.5664\/jcsm.8432","article-title":"Severe OSA associated with higher risk of mortality in stage III and IV lung cancer","volume":"16","author":"Huang","year":"2020","journal-title":"J Clin Sleep Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1214279","DOI":"10.3389\/fonc.2023.1214279","article-title":"Incidence disparities of obstructive sleep apnea-associated lung cancer by gender; Korean National Health Insurance data analysis","volume":"13","author":"Park","year":"2023","journal-title":"Front Oncol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"ref15","first-page":"1","article-title":"Age standardization of death rates: implementation of the year 2000 standard","volume":"47","author":"Anderson","year":"1998","journal-title":"Natl Vital Stat Rep"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Stat Med"},{"key":"ref17","volume-title":"Global Burden of Disease Study 2021 (GBD 2021) Socio-Demographic Index (SDI) 1950\u20132021","year":"2024"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1016\/j.hrtlng.2025.01.005","article-title":"Rising cardiovascular mortality among obstructive sleep apnea patients: United States epidemiological trends (1999-2019)","volume":"70","author":"Ali","year":"2025","journal-title":"Heart Lung"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"108783","DOI":"10.1016\/j.sleep.2026.108783","article-title":"Rising U.S. mortality associated with coexisting obstructive sleep apnea and obesity, 1999-2019","volume":"140","author":"Javeid","year":"2026","journal-title":"Sleep Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100148","DOI":"10.1016\/j.sleepx.2025.100148","article-title":"National trends in mortality associated with obstructive sleep apnea among adults with diabetes mellitus in the United States, 1999-2020","volume":"10","author":"Hassan","year":"2025","journal-title":"Sleep Med X"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1764594","DOI":"10.3389\/fcell.2026.1764594","article-title":"Obstructive sleep apnea and lung cancer: molecular underpinnings and clinical translational prospects","volume":"14","author":"Zhang","year":"2026","journal-title":"Front Cell Dev Biol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.5665\/sleep.6004","article-title":"Sleep apnea and Cancer: analysis of a Nationwide population sample","volume":"39","author":"Gozal","year":"2016","journal-title":"Sleep"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"101269","DOI":"10.1016\/j.lanepe.2025.101269","article-title":"Sex-specific associations between sleep apnoea and lung cancer risk in patients with COPD: a nationwide prospective cohort study","volume":"52","author":"Proesmans","year":"2025","journal-title":"Lancet Reg Health Eur"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1925388\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:51:11Z","timestamp":1790743871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1925388\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":23,"alternative-id":["10.3389\/fpubh.2026.1925388"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1925388","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1925388"}}