Trends and disparities in upper gastrointestinal cancer among patients with metabolic comorbidities: a retrospective CDC-WONDER analysis (1999–2020)

Upper gastrointestinal (UGI) cancers remain a major cause of cancer mortality in the United States. However, national mortality trends among individuals with metabolic comorbidities remain poorly characterized. A retrospective population-based study using the CDC WONDER Multiple Cause of Death database (1999–2020) identified deaths from esophageal or gastric cancer with metabolic comorbidities as contributing causes. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and stratified analyses by age, sex, race/ethnicity, urbanization, and state were performed. From 1999 to 2020, 45,086 deaths occurred among adults with UGI cancers and metabolic comorbidities. Overall AAMRs increased from 2.0 to 4.2 per 100,000, with a significant rise from 1999 to 2009 (APC 4.30%; 95% CI, 2.97–5.56; p < 0.01), a modest decline from 2009 to 2014 (APC − 3.50%; 95% CI, − 7.45 to 0.61; p = 0.08), and a sharp increase from 2014 to 2020 (APC 6.44%; 95% CI, 4.35–8.57; p < 0.01). Age-stratified analysis demonstrated the highest crude mortality among adults aged ≥ 85 years (5.2 to 9.3; APC 0.55%; 95% CI, 0.03–1.08; p = 0.03) and the lowest among those aged 45–54 years (0.1 to 0.3; APC 3.53%; 95% CI, 2.06–5.02; p < 0.01). Males consistently exhibited higher mortality than females (overall AAMR 2.7 vs. 1.0). The highest AAMRs were observed among non-Hispanic Black individuals (3.0), non-metropolitan areas (2.0), and the District of Columbia (2.7). UGI cancer mortality among individuals with metabolic comorbidities increased substantially from 1999 to 2020, with marked demographic and geographic disparities, highlighting the importance of incorporating metabolic comorbidities into UGI cancer prevention and survivorship strategies.