S630 Trends in Mortality and Racial Disparities in Familial Adenomatous Polyposis-Associated Colorectal Cancer: A 23-Year Analysis (1999–2022): A CDC WONDER Analysis

Introduction: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death worldwide. Familial adenomatous polyposis (FAP), confers a 100% lifetime risk of CRC, making it the primary cause of mortality in this population, highlighting the need for a prevalence-based mortality study. Methods: Mortality trends for adults aged ≥15 years were analyzed using the CDC WONDER database, identifying deaths through ICD-10 codes C18 “Colon Malignant neoplasms” and D12 “Familial adenomatous polyposis”. Age-adjusted mortality rates per 100,000 were extracted, and annual percent changes with 95% CIs were calculated across demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, regional) subgroups. Results: Between 1999 and 2022, 1,228,924 documented deaths were attributed to CRC due to FAP in the United States. The overall AAMR for FAP-related CRC mortality decreased in the US from an adjusted rate (AR) 30.7 in 1999 to 17.8 in 2022 (APC: -2.77%; 95% CI: -2.92% to -2.65%). In Texas, AAMR decreased from AR 29 in 1999 to 20 in 2022 (APC: -2.02%; 95% CI: -2.19% to -1.86%). Men had consistently higher AAMRs than women (21.3 vs 14.9). The AAMR in US men decreased from 38.1 in 1999 to 21.3 in 2022 (APC: -2.86%; 95% CI: -2.98% to -2.77%). The AAMR in US women decreased from 25.7 in 1999 to 14.9 in 2022 (APC: -2.78%; 95% CI: -2.94% to -2.65%). The non-Hispanic (NH) Black or African American (AA) population had the greatest AAMR (22.5), followed by the NH White (18.1) and NH American Indian or Alaska Native population (17.2). Lower-risk groups were the Hispanic or Latino population (14.6) and NH Asian or Pacific Islander (12.5). AAMR also varied by region (South: 16.1; Midwest: 15.6; Northeast: 14.3; West: 13.7). Non-metropolitan areas had higher AAMR (small metro: 15.2; non-core areas: 17.6; micropolitan areas: 18.9) than metropolitan areas (large central metropolitan areas: 14.2; large fringe: 13.8). The states in the upper 90th percentile were Nebraska, Louisiana, Arkansas, Wyoming, Alaska, Texas exhibited an approx. 2-fold increase in AAMRs, compared to states falling in the lower 10th percentile North Carolina, Wisconsin, Washington, Utah, Oregon. Conclusion: Mortality rates from Familial adenomatous polyposis-associated CRC have declined overall in the U.S. over the past 2 decades. NH Black or AA, NH White, and American Indian or Alaska Native men remain at high risk, emphasizing the need for further investigation regarding prevention strategies.