Mortality trends and disparities in ovarian cancer among women aged 45 years and older in the United States, 1999-2020: a CDC WONDER analysis

OBJECTIVE: Ovarian cancer remains a major cause of gynecologic cancer death in the United States, particularly among women aged 45 years and older. However, long-term national data on mortality trends and sub-group disparities in this population remain limited. We examined these patterns in a national mortality analysis. METHODS: Data on ovarian cancer deaths from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality database. Age-adjusted mortality rates per 100,000 population were calculated using the 2000 United States standard population. Joinpoint regression was used to assess temporal trends overall and by census region, urbanization status, and race. RESULTS: Ovarian cancer mortality declined significantly over the study period, with an overall average annual percentage change of -2.054% (95% confidence interval -2.175 to -1.924, p <.001). Following a stable trend during 1999-2002, mortality decreased significantly during 2002-2010, with an annual percentage change of -2.126% (95% confidence interval -2.453 to -1.579, p =.001), and during 2010-2020, with an annual percentage change of -2.878% (95% confidence interval -3.435 to -2.681, p <.001). Significant long-term declines were observed across all census regions, ranging from -2.039% in the South to -2.255% in the Northeast, while the West showed the steepest recent decline during 2016-2020, with an annual percentage change of -4.131%. Mortality also decreased in both metropolitan and non-metropolitan areas, with a slightly greater decline in metropolitan populations (-2.156% vs -1.938%). By race, mortality declined significantly among White, Black or African American, and Asian or Pacific Islander populations, but not among American Indian or Alaska Native individuals. CONCLUSIONS: Ovarian cancer mortality among US women aged 45 years and older declined significantly between 1999 and 2020. Nevertheless, persistent geographic and racial disparities suggest that progress in ovarian cancer outcomes has not been equitably distributed.