A two-decade analysis of gastric cancer mortality in the U.S.

e16038 Background: Gastric cancer (GC) is the fifth most common cancer globally and remains a significant public health burden, with approximately one million new cases and 783,000 deaths annually. Despite a 1.5% annual decline in prevalence, GC mortality varies by demographic and geographic factors. This study evaluates GC-related mortality trends in the U.S. from 1999 to 2020, focusing on differences by age, race/ethnicity, geography, and urbanization. Methods: Data were extracted from CDC WONDER database, covering GC-related deaths identified by ICD-10 code C-16 in adults above 25 years of age from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression analysis was performed to determine annual percent change (APC) with 95% confidence intervals (CIs), identifying significant temporal trends. Results: A total of 276,023 GC-related deaths were reported, with an overall AAPC of -2.60 (95% CI: -2.74 to -2.45). Mortality declined from 7.94 in 1999 to 4.66 in 2020. The sharpest decline occurred from 1999 to 2008 (APC: -3.31, 95% CI: -4.41 to -2.90), followed by a slower decline from 2008 to 2020 (APC: -2.06, 95% CI: -2.33 to -1.45). In metropolitan areas, mortality decreased from 8.26 to 4.77 (AAPC: -2.72, 95% CI: -2.83 to -2.62), while in non-metropolitan areas, rates declined from 6.71 to 4.15 (AAPC: -2.41, 95% CI: -2.67 to -2.12). By age, the 25-34 age group showed an increase from 1999 to 2012 (APC: 2.17, 95% CI: 0.71 to 22.82), followed by a decline from 2012 to 2020 (APC: -0.38, 95% CI: -1.17 to 2.66). Older age groups (≥45) exhibited consistent declines. The highest mortality was shown by 75-84 age group. Hispanic populations had a decline from 12.19 to 7.62 (AAPC: -2.31, 95% CI: -2.58 to -2.06). Among non-Hispanics, Whites had the highest mortality (AAPC: -2.96, 95% CI: -3.12 to -2.87), followed by Black (-3.25, 95% CI: -3.48 to -3.02), Asian/Pacific Islander (-3.83, 95% CI: -4.08 to -3.56), and American Indian/Alaska Native (-2.24, 95% CI: -3.00 to -1.36). The steepest regional decline occurred in the Northeast (AAPC: -3.12, 95% CI: -3.35 to -2.89). Conclusions: GC mortality has significantly declined across demographic and geographic subgroups over the past two decades. These reductions likely reflect advancements in early detection, treatment, and declining prevalence of risk factors such as Helicobacter pylori infection and smoking. However, disparities persist, necessitating targeted prevention and intervention efforts.