S872 Esophageal Cancer Incidence in the United States (1999-2021)

Introduction: Esophageal cancer remains a significant public health concern in the United States, marked by high incidence and notable disparities across age, sex, and racial/ethnic groups. While national rates have shown modest declines, the burden remains unevenly distributed across different populations. This study investigates trends in esophageal cancer incidence from 1999 to 2021, highlighting persistent disparities and informing targeted interventions. Methods: Data were extracted from the United States and Puerto Rico Cancer Statistics (1999-2021) by state and year for esophageal cancer. Age-adjusted incidence rates (AARs) per 100,000 were calculated using the 2000 U.S. standard population. Trends by sex, race/ethnicity, age, and state were analyzed using the Joinpoint Regression Program (version 5.3) to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals (CIs). Statistical significance was defined as P < 0.05. Results: Between 1999 and 2021, 376,766 cases of esophageal cancer were reported in the U.S. The overall AAR declined from 4.96 to 4.41 per 100,000. In 1999, non-Hispanic Black individuals had the highest AAR (7.46), while non-Hispanic Asians had the lowest (2.45). By 2021, non-Hispanic Whites had the highest AAR (4.70), and Asians remained the lowest (2.21). Men consistently had the highest AARs (1999: 8.59; 2021: 7.54), and women the lowest (1999: 2.09; 2021: 1.73). The most significant racial decline was observed in Black populations (AAPC: -4.11; 95% CI 4.28 to -3.93; P < 0.05), while Asian or Pacific Islanders showed the least significant improvement (AAPC: -0.98; 95% CI -1.44 to -0.53). Women showed greater improvement than men (AAPC: -1.00; 95% CI -1.00 to -1.00 vs -1.00; 95% CI -1.00 to 0.00). Among states, Arkansas was the only one with a significant increase in incidence (AAPC: +1.01; 95% CI 0.48-1.54). Crude rates were lowest in the 25-29 year age group (1999: 0.10; 2021: 0.08) and highest in the 75-79 year age group (1999: 25.94) and 80-84 year age group (2021: 26.35). Conclusion: Although the overall incidence of esophageal cancer declined from 1999 to 2021, persistent disparities by race, sex, age, and state reveal unequal progress. Black populations saw the greatest gains, yet men, older adults, and states like Arkansas remain disproportionately affected. Focused public health efforts are critical to closing these gaps.