S1019 Temporal Trends and Geographic Disparities in Upper Gastrointestinal Cancer Burden in the United States: A Nationwide Analysis Over 3 Decades

Introduction: Upper gastrointestinal (UGI) cancers, including esophageal and gastric malignancies, remain major contributors to morbidity and mortality in the United States (U.S.). Despite advances in care, disparities in disease burden persist, highlighting the need to understand temporal trends, geographic variation, and sociodemographic factors. We aim to conduct a retrospective study using the Global Burden of Disease (GBD) 2021 dataset to assess the burden and disparities in UGI cancers in the U.S. Methods: Data were extracted for all 50 states and the District of Columbia from the 2021 GBD study, including raw counts, age-standardized incidence rates (ASIR), death rates, and disability-adjusted life year (DALY) rates. Linear regression was used to calculate estimated annual percent changes (EAPCs). Relationships between EAPCs and the socio-demographic index (SDI) were evaluated for esophageal (EC) and gastric cancer (GC) using Pearson’s correlation. Statistical analyses were performed in R (v4.3.3), with significance set at P < 0.05. Results: In 1990, the number of EC cases was 12,883 (12,245-13,191), rising to 24,329 (22,769-25,279) by 2021, with a 0.96% increase in ASIR. Similarly, GC cases grew from 25,711 (24,106-26,591) to 28,458 (26,390-29,871), though ASIR declined by 44.6%. The ASDR for EC dropped by 3.5%, while GC saw a 47% decline. Men consistently had higher ASIR, mortality, and DALYs for both cancers in 1990 and 2021, despite larger relative declines over time. West Virginia had the highest EAPC in DALY rates for EC at 0.52 (0.45-0.60), while California had the greatest decline at -0.83 (-0.90 to -0.77). For GC, Kentucky showed the smallest EAPC drop at -0.54 (-0.62 to -0.47), while Hawaii had the steepest, at -2.78 (-2.89 to -2.68). Negative correlations were found between SDI and age-standardized DALY rates, with coefficients of -0.63 for EC and -0.86 for GC (P < 0.001 for both). Conclusion: Our study shows that incident cases of both EC and GC have increased over the past 3 decades. However, while the ASIR of GC declined, EC showed a slight increase. Despite these trends, the overall burden of both cancers, reflected in age-standardized death and DALY rates, decreased. Disparities were noted across genders and states, with men consistently bearing a higher burden and states with lower SDI showing worsening trends. These findings highlight the need for targeted public health efforts to advance healthcare equity and address these gaps.