A 21-year analysis of persistent disparities: Evaluating site-specific cancer mortality burden and trends among adult African Americans in the United States.

255 Background: Non-Hispanic African Americans (NHAA) face persistent disparities in cancer care, with higher mortality rates compared to other racial groups. These disparities reflect long-standing inequities in access to preventive care, timely diagnosis, and treatment for cancer in NHAA. We aimed to evaluate mortality burden and temporal trends in NHAA adults in comparison to non-Hispanic Whites (NHW) and Hispanic populations across multiple groups of cancer. Methods: We conducted a retrospective analysis of adults aged ≥25 years using the CDC WONDER Multiple Cause of Death database from 1999 to 2020. Relevant ICD Codes for eight major cancer groups were included individually: breast, bone, central nervous system (CNS), skin, respiratory, digestive (GIT), oropharyngeal, and genitourinary cancers. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population for NHAA, NHW, and Hispanic individuals. Annual percent change (APC) was determined using Joinpoint regression. For NHAA populations, AAMRs were further stratified by sex and U.S. census region. Results: From 1999-2020, we observed significant disparities in AAMR in NHAA population. (table 1) Mortality trends showed slight decline in the majority of cancer types across all racial groups (table 1). In addition, among NHAA, the cumulative AAMR across all cancer types was 384.0 in males and 235.4 in females. Regional variation was evident as well in NHAA: the Midwest reported the highest AAMR at 312.0, followed by the South (290.0), West (285.0), and Northeast (272.0). Conclusions: Our analysis show that non-Hispanic African Americans experience a disproportionately higher mortality burden in the majority of cancer types. These disparities are especially noticeable in GIT and genitourinary cancers. Although APC trends indicate declines in mortality rates over time, significant disparities continue to persist. Improved access to early detection and treatment, and structural reforms are essential to achieving equity in cancer outcomes for NHAA population. AAMR and APC for NHAA, NHW, and Hispanic populations across several cancer types (*= p <0.05). Cancer Type NHAA AAMR NHW AAMR Hispanic AAMR NHAA APC (%) NHW APC (%) Hispanic APC (%) Breast 32.8 23.7 14.6 *-1.47 *-1.8 *-1.07 Bone 0.709 0.672 0.567 *0.98 *0.97 0.82 CNS 4.05 7.83 4.4 0.37 *0.19 *0.53 Skin 1.5 7.6 2.11 *-1.77 0.11 -0.14 Respiratory 85.6 82.7 33.1 *-2.97 *-2.23 *-2.61 Digestive (GIT) 95.4 69.8 65.09 *-1.63 *-0.93 *-0.71 Oropharyngeal 5.64 4.9 2.8 *-2.74 0.23 *-0.99 Genitourinary 69.25 50.02 36.8 *-1.9 *-1.14 *-1.19