S711 Disparities and Trends in Gastrointestinal Cancer Mortality Among US Older Adults With Tobacco Use, 1999–2020

Introduction: Gastrointestinal tract (GIT) cancers remain a major contributor to morbidity and mortality, particularly in older adults. Tobacco use is a well-established carcinogen, and individuals who use tobacco may face elevated risks due to prolonged exposure and disparities in healthcare access. However, long-term mortality trends in this high-risk subgroup remain poorly characterized. This study evaluates national trends in GIT cancer mortality among U.S. adults aged ≥65 years with tobacco use from 1999 to 2020. Methods: Mortality data were obtained from the CDC WONDER Multiple Cause of Death database (1999–2020). Deaths among adults aged ≥65 years with GIT cancers (ICD-10 codes C15–C26) and documented tobacco use (ICD-10 code F17) were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Analyses were stratified by sex, race/ethnicity, U.S. Census region, and urban-rural status. Results: A total of 125,585 GIT cancer-related deaths were recorded among older adults with tobacco use. AAMRs showed a significant upward trend over the study period (AAPC = 16.26; 95% CI: 14.78–18.97; P < 0.01). Rates increased from 1.42 in 1999 to 10.73 in 2005 (APC = 52.63; 95% CI: 40.40–66.91), followed by a slower but sustained rise, reaching 20.64 in 2020 (APC = 4.27; 95% CI: 3.45–5.22). Men consistently exhibited higher AAMRs than women (22.23 vs 7.28), although both sexes experienced similar upward trends (AAPC: 13.08 for men vs 15.81 for women). Among racial and ethnic groups, Non-Hispanic American Indian/Alaska Native individuals had the highest AAMR (18.30), while Non-Hispanic Asian/Pacific Islanders had the lowest (4.48). Mortality rates were higher in rural compared to urban areas (18.02 vs 12.66). Regionally, the Midwest (18.51) and Northeast (13.97) reported higher AAMRs than the West (10.33) and South (12.39). State-level analysis revealed the highest AAMR in North Dakota (34.93) and the lowest in California (1.35). Conclusion: GIT cancer mortality among older adults with tobacco use has increased over the past 2 decades. Notable disparities by sex, race/ethnicity, geography, and rurality highlight the urgent need for targeted public health strategies. Expanding tobacco cessation programs, improving access to screening, and addressing healthcare gaps are essential to reducing mortality.