National trends and disparities in esophageal cancer and respiratory failure mortality among adults aged ≥45 years in the United States, 1999–2024: A CDC WONDER analysis.

e16021 Background: Esophageal cancer (EC) remains highly lethal in the United States, with approximately 22,370 new cases in 2024. Respiratory failure (RF) frequently complicates advanced disease, and deaths involving both conditions have risen substantially since 1999, necessitating population-based mortality analysis. This study aimed to characterize national mortality trends involving EC and RF, with a focus on demographic, geographic, and urban–rural disparities. Methods: We conducted a retrospective analysis of U.S. deaths associated with EC (C15) and RF (J96) among adults aged ≥45 years using data from the Centers for Disease Control and Prevention WONDER database. Age-adjusted mortality rates (AAMRs) per 1 million were computed and stratified by year of death, sex, race, census region, and urbanization. Joinpoint regression estimated Average Annual Percent Changes (AAPC) with 95% confidence intervals (CI). Results: Between 1999 and 2024, 32,348 deaths were attributed to EC and RF. National AAMRs increased during this period from 8.2 to 13.7 (AAPC: 2.18*; 95% CI: 1.70 to 2.67). Males bore a higher mortality burden than females (AAPC: 2.23*; 95% CI: 1.7 to 2.7). Mortality was elevated in both examined age groups (45-64 and 64-85+), with the most significant impact observed among individuals aged 65-85+ years (AAPC: 2.52*; 95% CI: 2.02 to 3.02). Race-stratified analysis revealed non-Hispanic (NH) White individuals demonstrated the most pronounced increase across the study period (AAPC: 2.72*; 95% CI: 2.19 to 3.25). Geographically, the Midwestern census region showed the steepest rise in mortality, with rural counties nationwide exhibiting a similar increase(In Table). Conclusions: Mortality due to EC and RF has increased insidiously over the past two decades, while the literature on the combined effects of diseases remains limited. The burden is disproportionately higher among males, adults aged ≥65 years, and NH White individuals, particularly in Midwestern and rural regions. These disparities highlight a growing public health burden and emphasize the need for targeted prevention, early detection, optimized respiratory and oncologic care, and region-specific policies to mitigate inequities. Variable AAMR 1999 AAMR 2024 AAPC (95% CI) Overall 8.2 13.7 2.18*(1.70-2.67) Gender:FemaleMale 3.714 5.123.8 1.73*(0.89-2.56)2.23*(1.71-2.75) Census region:NortheastMidwestSouthWest 8.277.510.8 15.513.412.214.9 2.43 *(2.05-2.82)3.22 *(2.38-4.07)1.91*(1.06-2.77)1.30 (-0.16-2.80) Age:45-64years65-85+years 415.5 5.727.7 1.37(-0.01-2.78)2.52*(2.02-3.02) Race:HispanicNH WhiteNH Black 5.27.712.8 9.514.411.2 2.54*(1.76-3.33)2.72*(2.19-3.25)-0.41(-1.33-0.52) Urbanization: (1999-2020)MetroNon-Metro 1999 8.56.9 2020 11.313.8 1.34*(0.83-1.85)3.47*(2.25-4.71) *Indicates p<0.05.