Demographic and Geographic Heterogeneity in Tongue Cancer Mortality in the United States, 1999–2020

Background: Tongue cancer remains a significant public health concern due to its persistently high mortality. However, population-level evidence on long-term trends and geographic inequities, particularly urban–rural disparities, remains limited. This observational ecological study examined national temporal trends and demographic and geographic heterogeneity in tongue cancer mortality. Methods: We analyzed mortality data from 1999– 2020 obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). Deaths were identified using ICD-10 codes C01–C02 as the underlying cause. Age-adjusted mortality rates (AAMRs) and estimated annual percent change (EAPC) were used to quantify trends. Analyses were stratified by sex, race or ethnicity, age group, US Census region, urbanization level, and state. Frontier analysis assessed the association between state-level mortality rates and the socio-demographic index (SDI). Results: A total of 47,943 tongue cancer deaths were recorded, with an overall AAMR of 0.660 per 100,000 population. Mortality increased modestly from 0.617 to 0.683 per 100,000 (EAPC, 0.262%). Urban–rural disparities were pronounced: urban rates remained stable (EAPC, 0.039%), whereas rural rates increased significantly (EAPC, 1.103%), reversing from lower than urban in 1999 to higher by 2020 (0.742 vs 0.662). Men experienced approximately threefold higher mortality than women, with increases confined to men. Mortality rose among White individuals but declined among Black individuals, and deaths were concentrated in older adults. Regionally, mortality increased in the Midwest and declined in the Northeast. Frontier analysis demonstrated an inverse association between SDI and AAMR. Conclusion: Tongue cancer mortality in the US has remained relatively stable overall but exhibits widening rural disadvantages, persistent male predominance, divergent racial trends, regional heterogeneity, and a concentration among older adults. These findings underscore the need for equity-focused, geography-based interventions, particularly in rural communities.