Abstract Body (Do not enter title and authors here): Background: Kidney cancer remains a significant contributor to cancer-related morbidity and mortality. Current projections estimate that the annual incidence will reach approximately 475,000 new cases by 2030. Furthermore, cardiovascular disease (CVD) is emerging as a leading non-cancer cause of death among kidney cancer patients, who face a nearly threefold higher risk of CVD-related mortality.This study aims to evaluate the shifting mortality landscape by examining the impact of CVD on overall mortality in patients with kidney cancer.

Methods: A retrospective analysis of CVD-related mortality in kidney cancer patients was conducted using the CDC WONDER database from1999 to 2020. Age-Adjusted Mortality Rates (AAMRs) per 100,000 and Annual Percent Change (APCs) with 95% CIs were determined. Joinpoint regression analysis was employed to examine trends across various demographic and regional groups.

Results: A total of 106,320 CVD-related mortality occurred in kidney cancer patients from 1999 to 2020, with 35.11% deaths occurring at the Decedent’s home. With an AAPC (Average Annual Percent Change) of 0.44 (95% CI: 0.23 to 0.72] the overall AAMR increased from 1.38 in 1999 to 1.58 in 2020. There was an upward trend between 1999 and 2006 (APC:0.71 CI: 0.01 to 2.96) followed by a downward trend till 2016 (APC:-0.85 CI:-2.82 to -0.43) followed by a significant increase till 2020 (APC:3.29 CI:1.69 to 6.49). Males consistently had higher AAMRs than females (2.19 vs 0.88). AAMRs differed markedly by race, with the highest rate among NH-American Indian or Alaska Native (1.95), followed by NH-Black or African American (1.58), NH-White (1.43), Hispanic (1.38), and the lowest in NH-Asian or Pacific Islander (0.74). The greatest rise in mortality was observed in NH-Black or African American from 2018-2020 (APC:6.17 CI:-0.66 to 10.36). 35-44 year age group had an overall rise from 1999-2020 (APC:1.04 CI:-0.03 to 2.18). Nonmetropolitan areas had the greatest increase from 1999-2020 (AAPC:1.39). Rhode Island, North Dakota, California, Oklahoma, Mississippi, and Nebraska exhibited AAMRs nearly twice as high as those in states within the lowest 10th percentile.

Conclusion: CVD-related mortality among kidney cancer patients presents with a concerning upward trend, with persistent demographic and geographic disparities. These trends further necessitate an integrated cardio-oncology approach to improve survival outcomes associated with two of the leading causes of death.