National Mortality Patterns of Cancer Cachexia in Gastrointestinal Malignancies in the United States: A Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Analysis (2018–2023)

BACKGROUND: Cancer cachexia is a multifactorial metabolic syndrome characterized by progressive weight loss, skeletal muscle wasting, anorexia, and systemic inflammation that cannot be fully reversed by conventional nutritional support. It frequently complicates advanced malignancy and is particularly prevalent in gastrointestinal cancers. Despite its clinical significance, population-level data describing mortality patterns involving cachexia among patients with gastrointestinal malignancies remain limited. OBJECTIVE: This study aims to evaluate national mortality trends and demographic disparities in individuals where cachexia was identified as a contributing cause of death among those with gastrointestinal malignancies in the United States. MATERIALS AND METHODS: We conducted a retrospective population-based cross-sectional study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database from 2018 to 2023. Deaths were included if gastrointestinal malignancy (ICD-10 codes C15-C26) was listed as the underlying cause of death and cachexia (ICD-10 code R64) was listed as a contributing cause. Annual mortality counts and crude mortality rates per 100,000 population were calculated and stratified by sex, race, and U.S. census region. RESULTS: A total of 3,888 deaths were identified during the study period, corresponding to an overall crude mortality rate of 0.20 per 100,000 population. Annual mortality remained relatively stable, ranging from 619 deaths in 2021 to 699 deaths in 2018, with crude mortality rates between 0.19 and 0.21 per 100,000. Men accounted for the majority of deaths (61.7%) and demonstrated higher mortality rates compared with women (0.24 vs 0.15 per 100,000). By race, White individuals demonstrated the highest crude mortality rate (0.22 per 100,000), followed by Black (0.18) and Asian (0.13) populations. Regional variation was also observed, with the highest mortality rates occurring in the Western United States (0.25 per 100,000), followed by the South (0.20), Midwest (0.18), and Northeast (0.13). CONCLUSIONS: Cachexia is documented in a measurable but likely underestimated proportion of deaths among patients with gastrointestinal malignancies in the United States. Significant sex, racial, and geographic disparities were observed in mortality patterns. These findings highlight the potential underrecognition of cancer cachexia and emphasize the importance of improved clinical awareness, documentation, and early integration of multidisciplinary supportive care strategies for patients with advanced gastrointestinal cancers.