S887 Trends in Esophageal Cancer Mortality in the United States (1999-2024): Disparities by Sex, Race/Ethnicity, Region, and Urbanization

Introduction: Esophageal carcinoma is the seventh most common cancer worldwide with poor overall survival rates. Impact of treatment advances on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality is essential for guiding targeted interventions. Methods: Using the CDC WONDER database, 1999 through 2024 were analyzed using ICD-10 code C15 for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 100,000 persons. Analyses stratified by gender (men, women), race (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural vs urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend. Results: From 1999 to 2024, there were 374,000 deaths from esophageal cancer across a population of over 8 billion. The overall age adjusted mortality rate (AAMR) declined, 4.36 (95% confidence interval [CI] 4.28-4.44) in 1999 to 3.69 (3.63-3.75) in 2024 (AAPC: -0.8%). Gender disparities persisted, with men having significantly higher mortality (6.43 per 100,000) compared to women (1.38 per 100,000) in 2024, though both showed declining trends (AAPC: -0.84% and -1.12%, respectively). By ethnicity, Black or African American individuals experienced the most pronounced change, from 6.61 to 2.73 (AAPC: -3.82%), with particularly steep declines after 2018 (APC: -1.58%). Hispanic populations saw moderate decreases from 2.54 to 1.99 (AAPC: -1.32%), while White populations showed minimal change from 4.3 to 4.28 (AAPC: -0.05%). Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC: -1.08%), followed by the Northeast from 4.61 to 3.57 (AAPC: -1.07%), the South from 4.23 to 3.56 (AAPC: -0.89%), and the Midwest showing the smallest decrease from 4.46 to 4.37 (AAPC: -0.31%). Urban areas decline (AAPC: -1.09%), while rural areas with modest increase from 4.16 to 4.52 (AAPC: 0.48%). Conclusion: Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2024, The most significant improvements occurred among African Americans, while rural areas showed increases in mortality rates. Persistent disparities by sex, ethnicity, and urbanization highlight the need for targeted prevention strategies and improved access to specialized care, particularly in rural settings.