Sex, racial and ethnic disparities in early-onset versus average-onset gastrointestinal cancers: A population-based analysis.

e15683 Background: Early-onset (EO) gastrointestinal (GI) cancers (diagnosed at 18–49 years) are increasingly recognized as distinct from average-onset (AO) cancers (≥50 years), yet limited data exist on racial and ethnic distributions. Methods: Using a large de-identified database (TriNetX) spanning multiple continents we identified 1,033,821 unique GI cancer cases. Chi-square tests assessed differences in sex, race, and ethnicity between EO and AO colorectal, gastric, esophageal, pancreatic, and biliary cancers. Results: White patients were disproportionately represented among AO esophageal (61 vs. 44%) and AO pancreatic (62 vs. 49%) cancer cases. Asian patients were more common in EO gastric cancer (15 vs. 11%), African American patients in EO pancreatic cancer (11 vs. 9%), and Hispanic patients across all EO cancer types (e.g., 8 vs. 4% in pancreatic). Females were more prevalent in EO gastric (45 vs. 34%), whereas men were more prevalent in AO gastric (60 vs. 48%). A substantial proportion of cases had unknown race or ethnicity, highlighting gaps in data reporting. Conclusions: EO GI cancers exhibit unique demographic patterns compared to AO cancers, with a significant overrepresentation of Hispanic and Asian individuals and a more diverse racial distribution. These findings underscore the need for targeted research to explore the underlying causes of these disparities and to guide tailored prevention and early detection strategies for at-risk populations. Demographics of patients with GI cancers. Demographics Colorectal (N = 605,872) Gastric (N = 107,424) Esophageal (N = 98,449) Pancreatic (183,642) Biliary (N = 38,434) EO AO EO AO EO AO EO AO EO AO Sex – N (%)FemaleMale 40,746 (47)39,336 (46) 188,223 (44)211,764 (49) 8,439 (45)8,977 (48) 32,423 (34)56,860 (60) 2,866 (26)7,711 (69) 18,953 (21)68,492 (74) 9,275 (51)8,733 (48) 73,067 (46)82,126 (51) 2,170 (43)2,813 (56) 15,124 (45)17,449 (52) Race – N (%)WhiteAfrican AmericanAsianOtherUnknown 40,883 (47)7,234 (8)9,049 (10)5,878 (7)23,296 (27) 232,462 (54)34,661 (8)31,674 (7)22,887 (5)106,832 (25) 6,695 (36)1,522 (8)2,758 (15)2,063 (11)5,634 (30) 42,806 (45)8,186 (9)10,332 (11)7,760 (8)25,211 (27) 4,967 (44)701 (6)1,884 (17)793 (7)2,818 (25) 56,101 (61)5,202 (6)6,534 (7)5,107 (6)19,172 (21) 8,971 (49)2,008 (11)1,976 (11)1,195 (6)4,115 (23) 98,265 (62)14,559 (9)9,199 (6)8,229 (5)29,381 (18) 2,601 (52)610 (12)492 (10)280 (5)1,044 (21) 19,325 (58)2,568 (8)3,363 (10)1,849 (6)6,302 (19) Ethnicity – N (%)Not HispanicHispanicUnknown 41,761 (48)5,059 (6)39,429 (46) 213,629 (50)17,211 (4)197,540 (46) 7,415 (40)1,536 (8)9,721 (52) 43,429 (46)4,565 (5)46,301 (49) 5,475 (49)438 (4)5,250 (47) 48,224 (53)2,269 (2)41,307 (45) 9,818 (54)1,414 (8)7,033 (39) 93,968 (59)6,845 (4)58,820 (37) 2,587 (51)936 (19)1,504 (30) 19,591 (59)2,070 (6)11,746 (35) All p-values in the table are < 0.005.