Trends in adrenocortical cancer mortality in the US from 1999 to 2020: Regional, demographic and geographic disparities.

e23069 Background: Adrenal masses can be either benign or malignant, with adrenocortical carcinomas, being much less common than adrenal adenomas, having an incidence of 0.5–2 cases per million worldwide. Early-stage adrenal cancer has a five-year survival rate of 50-60%, but only 10-20% after metastasis. This study aims to examine the disparities influencing mortality from adrenocortical carcinomas across the U.S. population using data from a national database. Methods: A retrospective observational analysis was performed, utilizing data from all 50 U.S. states and the District of Columbia with regards to adrenal cancer mortality. The study used death certificates from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, from 1999 to 2020. ICD-10 code C74 was used in multiple causes of death database to identify cases. Results were reported as Age-Adjusted Mortality Rates (AAMR) per million with 95% confidence intervals (CIs) and Annual Percentage Changes (APC). Results: Between 1999 and 2020, a total of 14,622 deaths were attributed to adrenocortical cancer. The age-adjusted mortality rate (AAMR) decreased from 2.429 (95% CI: 2.245–2.614) in 1999 to 2.068 (95% CI: 1.918–2.219) in 2020, reflecting an annual percentage change (APC) of –0.78. Regional analysis revealed the highest mortality rates in the Midwest, where the AAMR decreased from 2.645 (95% CI: 2.247–3.044) in 1999 to 2.211 (95% CI: 1.87–2.552) in 2020, with an APC of –0.63. Mortality was higher in men than in women, with AAMR decreasing from 2.653 in 1999 to 2.12 in 2020. Racial stratification indicated that the White population had the highest mortality rates, which decreased from 2.548 in 1999 to 2.157 in 2020. Mortality was the highest in individuals aged 65+, with AAMR remaining elevated over the two decades—7.08 in 1999 and 6.83 in 2020, reflecting a minimal APC of 0.01. Geographic differences were also observed, with mortality in non-metropolitan areas showing a slight increase (APC: 0.27), while metropolitan areas observed a more significant decline (APC: –1.00). Conclusions: Adrenocortical cancer mortality has generally declined from 1999 to 2020, with notable regional, demographic, and geographic disparities. These trends emphasize the need for targeted interventions, particularly for older individuals, men, and those in non-metropolitan areas, to address these disparities. Demographic characteristics of deaths due to adrenocortical cancer in the United States from 1999-2020. Variable Subgroup Deaths AAMR (95% CI) per 1000,000 Overall Overall 14,622 2.09 (2.06-2.13) Gender Male 7,270 2.21 (1.97-2.45) Female 7,352 1.97 (1.76-2.19) Race Hispanic 1,133 1.37 (0.99-1.85) Black 1,671 1.93 (1.51-2.44) White 12,473 2.16 (1.98-2.34) Age (years) 25-44 1,349 0.74 (0.56-0.95) 45-64 3,934 2.24 (1.91-2.58) 65+ 5,608 6.09 (5.33-6.84)