Cancer mortality burden and trends in the adult Native American population in the United States: A 21-year national analysis across several groups of malignancies.

257 Background: American Indian and Alaska Native (AI/AN) populations remain underserved in cancer control efforts. There is limited large-scale mortality trend data available. We aimed to evaluate site-specific cancer mortality rate and trends among AI/AN individuals to quantify burden and identify areas of intervention. Methods: We used CDC WONDER Multiple Cause of Death data (1999–2020) to assess mortality from seven major sites of cancer: breast, respiratory, oropharyngeal, digestive tract, genitourinary tract, hematologic malignancies, and central nervous system (CNS). Relevant ICD codes were used, and adults aged > 25 years were included in analysis. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for AI/AN individuals. Joinpoint regression analysis was used to calculate overall annual percent change (APC). Cumulative AAMR was further stratified by sex and census region. Results: Among AI/AN populations, the highest mortality burden was observed in digestive tract (AAMR 56.49), respiratory (49.3), and genitourinary cancers (33.88), followed by hematologic malignancies (17.02), breast (12.96), oropharyngeal cavity (3.17), and CNS cancers (2.91). The cumulative AAMR across all seven cancer types was 207.0 for males and 147.0 for females, reflecting a substantial gender disparity. Regional cumulative AAMR was also observed: the Midwest had the highest overall AAMR (234.08), followed by the West (174.96), South (169.41), and Northeast (84.01). Mortality trends showed declines across most cancer types, with the following APCs from 1999-2020: Digestive: –0.95 (p < 0.05) Lung: –2.45 (p < 0.05) Genitourinary: –1.51 (p < 0.05) Hematologic: –1.86 (p < 0.05) Breast: –1.65 (p < 0.05) Oral Cavity: –2.42 (p < 0.05) CNS: –0.59 (not significant). Conclusions: Our analysis shows that cancer mortality among Native American populations has declined over the past two decades across most malignancies. However, the burden remains disproportionately high in gastrointestinal, respiratory, and genitourinary cancers. Additionally, there are notable sex- and geography- based differences as well. This underscores the need for targeted cancer prevention, early detection, and culturally tailored interventions to improve equity in cancer outcomes for AI/AN communities.