S994 Temporal Trends in Esophageal Cancer Mortality in the United States by Year, Sex, and Race (1999-2020): A Population-Based Study

Introduction: Esophageal cancer is the fourth most common gastrointestinal cancer in the U.S., with significant mortality rates. This study aimed to assess temporal trends in esophageal cancer-related mortality among U.S. adults by year, sex, and race. Methods: We used the CDC WONDER database to determine age-adjusted mortality rates (AAMRs) of esophageal cancer in the U.S. from 1999 to 2020 in adults aged ≥35 years. AAMRs per 100,000 were stratified by year, sex, and race. Statistical analysis, including regression and 2-sample t tests, was performed using Microsoft Excel. Joinpoint regression was used to assess trends, reported as annual percent change (APC) and average annual percent change (AAPC). A P-value < 0.05 was considered statistically significant. Results: Between 1999 and 2020, 309,054 esophageal cancer deaths were recorded, with an overall AAMR of 8.06 (95% confidence interval [CI] 8.03-8.08; P < 0.05). AAMRs declined from 8.51 in 1999 to 7.16 in 2020 (AAPC -0.78; 95% CI -0.59 to -0.9; P < 0.000001). Men consistently had higher rates than women (14.28 vs 3.05; P < 0.000001). While linear regression showed a steeper decline in men, Joinpoint analysis revealed a greater AAPC in women (-1.45 vs -0.77; P < 0.000001), highlighting the importance of using segmented models to capture evolving trends. Significant differences were also noticed across racial groups. Whites had the highest mean AAMR (8.26), followed by Blacks (7.97), American Indians (4.95), and Asians (3.23). Blacks initially had the highest mortality (12.73 in 1999) but saw a significant decline to 5.13 in 2020 (AAPC -4.51; 95% CI -4.32 to -4.69; P < 0.000001). Whites showed persistently high rates with an increase from 8.16 in 1999 to 8.7 in 2006 (APC 0.74; 95% CI 1.75 to 0.2; P < 0.01), followed by a modest decrease to 7.74 in 2020 (APC -0.71; 95% CI -0.52 to -0.96; P < 0.000001). While Asians demonstrated persistently lower rates (AAPC -1.45; 95% CI -0.88 to -1.89; P < 0.000001), American Indians showed more variable trends, likely due to smaller population sizes (AAPC -1.62; 95% CI -0.44 to -2.57; P < 0.006). Conclusion: Esophageal cancer mortality has declined overall, but disparities by gender and race persist. Men had higher mortality, though women showed a steeper decline. Blacks demonstrated the greatest improvement, while Whites continued to have the highest mortality. These findings highlight the need for targeted interventions and the utility of Joinpoint regression in capturing temporal patterns often missed by linear models.