Colorectal cancer (CRC), the third most common cancer and the second leading cause of cancer-related deaths in the United States, accounted for an estimated 147,950 new cases and 53,200 deaths in 2020.1,2 While the incidence of CRC is rising, particularly among younger adults, mortality rates have shown a promising decline, largely due to advancements in screening and treatment modalities.1,3 Concurrently, heart failure (HF) remains a leading cause of morbidity and mortality worldwide, with a notable increase in prevalence partly due to aging populations and improved survival rates from other cardiovascular conditions4 Emerging evidence underscores a concerning bidirectional relationship between CRC and HF, where each condition may exacerbate the severity of the other. This may be attributed to an overlap between major risk factors and certain pathophysiological pathways.5,6 This study leverages a comprehensive database to explore these intersecting trends, aiming to highlight the underlying demographic and geographical disparities that could guide tailored public health interventions and policymaking.

Recent studies have shown that people with HF are more likely to develop various cancers, including breast, lung, blood cancers, and colorectal cancer (CRC). This complex interplay suggests that patients suffering from both conditions are likely to experience worse outcomes and more challenging clinical management. This increased risk is linked to common factors like chronic inflammation and hormonal imbalances in the body. Lifestyle habits such as smoking and excessive alcohol use, along with obesity and high blood pressure, also contribute to this heightened risk which could prime the onset of cancer. These findings underscore the importance of integrated care that tackles both heart and cancer risk together.7, 8, 9, 10

Notably, a longitudinal study of older adults with non-metastatic CRC found a 10-year cumulative incidence of HF at an alarming 54.5 %, compared to 18 % in a matched control group, underscoring the profound impact of these comorbid conditions on patient outcomes11 The risk was considerably higher among older patients and those with pre-existing conditions like diabetes and hypertension11 Recent evidence also pointed to the demographic and geographical variations in the prevalence and outcomes of CRC and HF, suggesting that certain populations are disproportionately affected. Socioeconomic status, access to healthcare, and regional policies can significantly influence both the incidence and outcomes of these conditions.7, 8, 9, 10

Given these complexities, our study seeks to fill a critical gap in understanding how geographic and demographic disparities affect mortality related to both CRC and HF. By utilizing data from the CDC WONDER database, this study aims to analyze trends in CRC and HF-related mortality from a period of 1999 to 2020. This study is the first to systematically examine the combined effects of CRC and HF across such an extensive timeframe and diverse population, providing invaluable insights that could help guide future public health strategies and healthcare practices.