S496 Reversal of Racial Disparity in Colorectal Cancer Mortality in United States (1999-2023)

Introduction: Colorectal cancer (CRC) has historically shown marked racial disparities in the United States, with Black Americans bearing a disproportionate burden of incidence and mortality. In response, the past 2 decades have seen targeted efforts to expand screening access, improve early detection, and promote treatment equity. This report examines trends in CRC mortality by race over time, with particular emphasis on the impact of public health interventions on shifting patterns. Methods: We extracted CRC mortality data International Classification of Diseases, Tenth Revision code: C18–C20) from CDC WONDER for 1999–2023, stratified by race (White, Black), age <55, and sex. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 using the 2000 U.S. standard population. Joinpoint regression and trend projections were performed in R (v4.3.2) using the segmented, dplyr, and forecast packages. SEER data were used to cross-validate incidence rates and denominator consistency. Annual percent change (APC) and forecast models through 2030 were generated to assess emerging trends. Results: From 1999 to 2023, CRC mortality in individuals <55 declined in Blacks (from 4.2 to 3.5 per 100,000; APC –0.8%) but rose in Whites (2.4 to 3.1 per 100,000; APC +1.4%). White males had the steepest increase. Projected models indicate White early-onset CRC mortality could surpass Black rates by 2028. This demographic shift highlights emerging disparities not captured by aggregate trends and underscores the urgency for age- and race-targeted screening policies. Conclusion: A striking reversal of CRC mortality trends has occurred over the past 2 decades. While targeted efforts have substantially reduced disparities among Black Americans, the recent rise in early-onset CRC mortality among Whites—particularly in rural and low-income communities—warrants urgent attention. If current trends persist, CRC mortality in young White adults is projected to surpass that in Black populations by 2028. Shifting CRC mortality trends demonstrate that disparities are not inevitable but are modifiable through sustained, targeted public health efforts. The narrowing Black-White mortality gap highlights the impact of equitable screening and care. However, rising mortality among young, low-income Whites signals a new disparity. Future research should further elucidate the biological, behavioral, and systemic drivers of this trend to inform precision-targeted prevention strategies.