S864 Characteristics of Early-Onset vs Late-Onset Esophageal Adenocarcinoma: Insights From the National Inpatient Sample 2016-2020

Introduction: The incidence of esophageal adenocarcinoma (EAC) in adults under 50 years of age (early-onset EAC) continues to rise rapidly in the United States. While young patients represent only a small subset of individuals diagnosed with EAC, they often present with more advanced stages of disease, leading to worse survival outcomes. This study aims to evaluate the influence of specific predictors in early-onset EAC compared to late-onset EAC (adults aged >50 years). Methods: We utilized the National Inpatient Sample (NIS) to identify adult patients (>18 years) diagnosed with EAC between 2016 and 2020. Patients were stratified into early-onset and late-onset EAC based on age. Diagnoses were identified using International Classification of Diseases-10-CM codes, validated in prior studies. The anatomical location of the cancer further categorized cases into upper-third, middle-third, and lower-third regions. Predictors, including patients’ demographics, comorbidities, region, hospital type, and median income, were analyzed. Statistical analysis was performed using Stata version 17.0, with the Rao-Scott Chi-square test applied for categorical variables to account for the complex survey design. Results: A total of 105,228 EAC admissions (9,190 upper-third; 17,569 mid-third; and 78,469 lower-third) were identified from the NIS database between 2016 and 2020. Early-onset EAC accounted for 5%-6% of total EAC cases across all anatomical subtypes. Across all age groups, EAC was most frequently located in the lower esophagus. EAC was more prevalent among White men and individuals with higher income levels. The early-onset group showed a higher proportion of Black and Hispanic individuals and fewer White individuals compared to the late-onset group. Smoking, alcohol use, obesity, and drug use were more prevalent in the early-onset group, whereas hypertension, diabetes mellitus, and chronic obstructive pulmonary disease were more common in the late-onset group. Conclusion: Early-onset EAC is an unexpected diagnosis in the young population due to its rare incidence and the limited epidemiological information available, including its risk factors. This study highlights that early-onset EAC exhibits racial variations and differences in the prevalence of risk factors, diverging from the patterns observed in older populations. Our findings underscore the need for further large-scale research comparing early-onset EAC with overall EAC to better understand these differences and to guide targeted screening and preventive measures.