21 years of tonsillar cancer mortality: Trends, disparities, and public health challenges.

e22553 Background: Tonsillar squamous cell carcinoma (SCC), the most common oropharyngeal cancer, has shown increasing mortality trends despite declining traditional risk factors like tobacco use. Using CDC WONDER data from 1999 to 2020, this study examined demographic and geographic disparities in age-adjusted mortality rates (AAMRs) for individuals aged ≥25 years. Methods: Data was extracted from the CDC-WONDER database using ICD-code C09, specific to age-adjusted mortality rates (AAMR) due to tonsillar cancer per 100,000 population. Analysis was conducted using Joinpoint v5.3 to calculate average annual percent change (AAPC) and annual percent change (APC). Results: A total of 21,665 deaths were analyzed, revealing an overall AAMR increase from 0.42 in 1999 to 0.50 in 2020, with an AAPC of 1.16% (p<0.000001). The overall AAMR declined from 1999 to 2005 insignificantly, which was followed by an increase in AAMR with an APC of 1.84 (95% CI -0.60 to 4.77, p=0.05). Male mortality was significantly higher (AAMR: 0.75) than female (AAMR: 0.17) with a 2.78% annual increase (p=0.02). African Americans initially had the highest mortality, but rates declined (-1.96% AAPC, p=0.0004), while White populations experienced a significant rise (2.42% AAPC, p<0.000001). Mortality rates were highest among individuals aged 65–84 years and disproportionately affected rural areas (AAMR: 0.49) compared to urban areas (AAMR: 0.46). Geographic variability was notable, with rural and southern regions showing higher mortality. Maine had the highest AAMR of 0.67 (95% CI 0.57 to 0.78), while lowest AAMR was recorded in Utah (0.15 (95% CI 0.11 to 0.20)) from 1999 to 2020. Other states in the upper 90th percentile of tonsillar cancer related mortality included District of Columbia, Kentucky, Tennessee, Vermont and Washington whereas states in the lower 10th percentile included Alaska, Hawaii, New Jersey, New York and Rhode Island. The highest AAMR for tonsillar cancer was recorded in the Midwest (0.48, 95% CI 0.47 to 0.50), followed by the South (0.47, 95% CI 0.46 to 0.48) and West regions (0.40 95% CI 0.39 to 0.41) with lowest in Northeast region (0.36, 95% CI 0.35 to 0.38). Conclusions: These findings highlight increasing tonsillar cancer mortality among males and Whites and persistent rural disparities. Public health interventions focusing on HPV vaccination, early detection, and addressing healthcare inequities are critical for mitigating these trends. Deaths and age-adjusted mortality rates (AAMRs) per 1,000,000 for tonsillar cancer among patients in the United States by race/ethnicity between 1999 and 2020. Variable Deaths (n) AAMR (95% CI) Overall 21,665 0.46 (0.45 to 0.47) Female 4,669 0.17 (0.16 to 0.17) Male 16,996 0.46 (0.45 to 0.47) American Indians 103 0.31 (0.24 to 0.37) Asians 225 0.11 (0.09 to 0.12) Blacks 2,643 0.53 (0.51 to 0.55) Whites 17,722 0.48 (0.48 to 0.49) Hispanics 898 0.21 (0.19 to 0.22)