S1041 Temporal Trends of Esophageal Cancer-Associated Mortality Among Individuals With Hypertension in the United States from 1999-2023: A Nationwide Analysis Using the CDC WONDER Data

Introduction: Esophageal cancer is the sixth leading cause of cancer-related deaths in the U.S., with a 5-year survival rate of just 20%, despite treatment advances. Known risk factors include smoking, alcohol use, and gastroesophageal reflux disease. Emerging evidence suggests hypertension affects nearly half of U.S. adults and may contribute to cancer progression via vascular or inflammatory pathways. However, its link to esophageal cancer mortality remains under-explored, limiting targeted prevention efforts. Methods: We analyzed CDC WONDER data (1999-2023) on adults ≥45 years with esophageal cancer (International Classification of Diseases (ICD)-10: C15) as the underlying cause of death and hypertension (ICD-10: I10-I15) as a contributing cause. Mortality rates (crude and age-adjusted per 100,000) were stratified by age, sex, race/ethnicity, region, and urbanization. Join-point regression was used to assess trends, reporting annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs) (P < 0.05). Results: Between 1999 and 2023, 25,421 U.S. adults with hypertension died from esophageal cancer. The age-adjusted mortality rate (AAMR) rose from 1.24 to over 4 per 100,000. The steepest rise occurred from 1999-2001 (APC: 22.1%), with an overall annual increase (AAPC) of 5.31%. Men (AAMR: 4.49) had higher rates than women (1.09). The highest crude mortality was among those ≥85 years (26.24/100,000), and the lowest in the 45-54-year age group (0.89/100,000). Rural areas had higher AAMR (3.05) than urban (2.63). Non-Hispanic Blacks had the highest mortality (3.45), followed by Whites (2.92) and Asians/Pacific Islanders (1.46). The South region saw the greatest burden. Oklahoma had the highest AAMR (4.44), while California had the most deaths (2,468). Conclusion: Esophageal cancer mortality in patients with hypertension has shown a rising trend in U.S. adults over the past 2 decades, with particularly high rates among men, non-Hispanic Whites, and residents of urban and Southern regions. These findings suggest a potential vascular-oncologic link, possibly mediated by vascular endothelial growth factor, which connects hypertension-induced endothelial dysfunction with tumor angiogenesis. Further research is warranted to explore causal mechanisms and develop targeted prevention strategies. Focused screening and resource allocation for high-risk groups may help reduce esophageal cancer-related mortality.