3 Background: Anal cancer rates have climbed markedly in recent decades, with parallel rises in incidence and mortality. We examined disparities in mortality trends by sex, race, census region, and urbanization among U.S. adults aged ≥65 years. Methods: Mortality data from CDC WONDER (1999-2023) were analyzed for anal cancer (ICD-10 C21) as underlying cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000. joinpoint regression estimated annual percentage changes (APCs) with 95% confidence intervals (CIs). Results: A total of 15,690 deaths were recorded; the overall AAMR rose from 9.38 to 23.06. AAMRs rose in both sexes, higher in women from 10.9 to 27.7 than men from 7.1 to 17.3, with women showing a steeper, significant post-2015 acceleration (APC 8.80; 95% CI 5.27-12.33; p<0.001). White adults consistently had higher AAMRs and showed a marked post-2014 acceleration (APC 7.58%, 95% CI 6.45-8.73; p<0.001), whereas Black adults had lower AAMRs but rose steadily across 1999-2023 (APC 3.04, 95% CI 2.30-3.78; p<0.001). Upward inflections were noted in the South post-2014 (APC 8.50, 95% CI 7.04-9.96; p<0.001) and the West post-2015 (APC 7.03, 95% CI 4.61-9.50; p<0.001). Metro areas showed a significant surge in AAMRs after 2016 (APC 10.17; 95% CI 7.13-13.30; p=0.00001), whereas non-metro areas rose more slowly without a post-2016 inflection (APC 3.76; 95% CI 2.96-4.58; p<0.001). Conclusions: Anal cancer mortality has doubled, with mid-2010s accelerations in women (post-2015), White adults (post-2014), the South (post-2014), the West (post-2015), and the metropolitan areas (post-2016). Deaths and age-adjusted mortality rates (AAMRs) per 1,000,000 for trends related to anal cancer mortality in adults in the United States between 1999 and 2023. Variable Deaths (n) AAMR (95% CI) 1999 AAMR (95% CI)2023 Overall 15,690 9.38 (8.36-10.40) 23.06 (21.81-24.32) Sex Female 10,184 10.90 (9.48-12.31) 27.68 (25.38-29.51) Male 5,506 7.09 (5.73-8.69) 17.30 (15.31-18.96) Race NH Black 1,172 7.42 (4.85-11.72) 17.65 (14.17-21.71) NH White 13,456 9.27 (8.17-10.37) 26.24 (24.70-27.78) Census region Northeast 2,776 7.88 (5.99-10.19) 19.78 (17.09-22.47) Midwest 3,292 8.34 (6.49-10.55) 20.7 (18.11-23.29) South 5,780 10.01 (8.23-11.78) 24.39 (22.29-26.49) West 3,842 11.19 (8.82-14.01) 25.88 (23.08-28.68) Urbanization Metropolitan 9,825 9.3 (8.17-10.43) 20.12 (18.8-21.44) Non-metropolitan 2,089 9.76 (7.54-12.44) 18.63 (15.81-21.45)
Ibrahim et al. (Sat,) studied this question.