S1044 Mortality Trends and Disparities in Esophageal Cancer in the United States, 1999-2023: An Analysis of the CDC WONDER Database

Introduction: Esophageal cancer accounts for over 16,000 deaths annually in the United States and has a 5-year survival rate of approximately 21%. Although it is relatively rare, it disproportionately contributes to cancer mortality due to late-stage diagnosis. This study aims to examine temporal patterns and regional disparities in esophageal cancer-related mortality across the United States from 1999 to 2023. Methods: Mortality data for esophageal cancer among individuals aged ≥25 years were extracted from the CDC WONDER Multiple Cause of Death database using the International Classification of Diseases-10 code C15. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) were calculated per 100,000 people. Temporal trends were evaluated using Joinpoint regression analysis to estimate the annual percent change (APC) and average annual percent change (AAPC). Results: Between 1999 and 2023, there were 390,617 esophageal cancer-related deaths in the U.S. The overall AAMR showed a significant overall decline (AAPC: -0.68%; 95% confidence interval [CI] -0.88 to -0.49), with a notable decrease from 2005 to 2018 (APC: -1.09%; P < 0.01), but no significant change during 1999-2005 (APC: -0.08%) and 2018-2023 (APC: -0.35%). The AAMR was higher in men (12.25) compared to women (2.62). Racial and ethnic disparities were evident: Non-Hispanic (NH) White individuals experienced the highest AAMR (7.50), followed by NH Black (7.05), NH American Indian/Alaska Native (5.46), Hispanic (3.63), and NH Asian/Pacific Islander (2.84) groups. Regionally, the Midwest recorded the highest AAMR (7.82), followed by the Northeast (7.31), South (6.57), and West (6.27). States with the highest mortality included Maine, New Hampshire, Ohio, West Virginia, and Vermont. Non-metropolitan areas exhibited higher mortality than metropolitan areas (AAMR: 7.78 vs 6.80). Adults aged ≥65 years had the highest CMR (23.75). Most deaths occurred at home (41.30%) or in medical facilities (34.70%). Conclusion: While esophageal cancer mortality in the U.S. declined overall from 1999 to 2023, this decline was not consistent across different population groups. Men, White individuals, residents of the Midwest, and those in non-metropolitan areas continue to face a disproportionate burden. These patterns suggest that advancements in prevention, early detection, and treatment have not been equally accessible to all populations. To address these persistent gaps, tailored public health interventions are needed for high-risk communities.