Temporal trends and disparities in gallbladder cancer mortality: A U.S. population-based study.

e16175 Background: Gallbladder cancer (GBC) is a relatively uncommon malignancy with one of the most unfavorable prognoses among gastrointestinal cancers and is characterized by marked geographic, racial, and sex-based disparities. Despite declining incidence in many regions, comprehensive national evaluations of long-term GBC mortality trends in the United States remain limited. Methods: Death certificate records from CDC WONDER were analyzed for decedents aged 25 years and above with gallbladder cancer (ICD-10 code C23) listed as the cause of death during 1999–2020. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APC) were derived, with results stratified by sex, age group, racial group, U.S. Census region, and urban–rural status. Statistical significance was determined at a p-value of < 0.05. Results: From 1999–2020, GBC accounted for 47,504 deaths in the United States. The AAMR declined significantly from 2.32 in 1999 to 1.62 in 2020 (APC −1.44; 95% CI −1.65 to −1.24), with an overall AAMR of 1.83 (95% CI 1.81 to 1.85). Overall AAMR remained higher in females (2.21) compared to males (1.35). Female AAMR decreased from 2.78 to 1.96 (APC −1.45, 95% CI: -1.68 to -1.22), while male AAMR declined from 1.60 to 1.25 (APC −1.20, 95%CI -1.47 to -0.92). Age-stratified analysis showed substantially higher mortality in older adults. AAMR declined from 5.01 to 3.38 (APC −1.60) in the older age group, compared with a smaller decline in the middle-aged group (0.79 to 0.61; APC −0.91). Mortality among young adults was too sparse for trend analysis. By race/ethnicity, the highest overall AAMR was observed among Hispanic/Latino individuals (2.83), followed by Black/African American (2.60), Asian/Pacific Islander (2.09), and White populations (1.64). Significant declines were observed among Whites, Hispanics/Latinos, and Asian/Pacific Islanders, while trends among Black/African American individuals remained stable. Geographically, states in the highest AAMR decile included New York, New Mexico, and the District of Columbia, whereas Montana had the lowest overall AAMR. Mortality was higher in metropolitan compared with non-metropolitan areas throughout the study period. Regionally, the Northeast had the highest overall AAMR, followed by the Midwest, West, and South, despite significant declines across all regions. Conclusions: Although GBC mortality has declined nationwide over the past two decades, disparities persist by sex, race/ethnicity, geography, and urbanization. NH Black and Hispanic populations, as well as residents of high-burden states, continue to face disproportionate mortality. Targeted prevention, early detection, and equitable treatment access are urgently needed to reduce these inequities.