Trends and disparities in esophageal cancer mortality in the United States, 1999-2023.

e16102 Background: Esophageal cancer remains a significant cause of cancer mortality in the United States. While overall trends have been reported, less is known regarding contemporary long-term patterns and specific disparities across demographic and geographic strata. We aimed to characterize esophageal cancer mortality trajectories and identify populations with divergent outcomes by age, race/ethnicity, geographic region, and urbanization status. Methods: We analyzed esophageal cancer mortality data from 1999 to 2023 using the Centers for Disease Control and Prevention (CDC) WONDER database. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. standard population. Joinpoint regression analysis was utilized to estimate the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Analyses were stratified by age, sex, race/ethnicity, census region, state, and urbanization level. Results: Overall esophageal cancer mortality in the U.S. declined significantly from 1999 to 2023 (AAPC, -0.81%; 95% CI, -0.97% to -0.65%; P < 0.001). Declines were observed across most age groups, with the steepest reductions among adults aged 45-54 years (AAPC, -1.68%; 95% CI, -2.01% to -1.35%) and 55-64 years (AAPC, -1.25%; 95% CI, -1.51% to -0.99%). Marked racial and ethnic disparities were identified. Non-Hispanic (NH) Black individuals experienced the most rapid decline (AAPC, -4.07%; 95% CI, -4.42% to -3.72%). Conversely, trends among NH White individuals remained stable overall (AAPC, -0.05%; P = 0.59), characterized by an initial increase from 1999 to 2005 (APC, 1.14%; P = 0.002) followed by a modest decline from 2005 to 2023 (APC, -0.44%; P < 0.001). Regionally, the West demonstrated the largest decline (AAPC, -1.13%; 95% CI, -1.26% to -0.99%), followed by the Northeast (AAPC, -1.05%). West Virginia was the only state to exhibit a significant increase in mortality (AAPC, 1.01%; 95% CI, 0.38% to 1.64%; P = 0.003). Mortality declined significantly in metropolitan areas (AAPC, -1.09%; P < 0.001), while trends in nonmetropolitan areas remained stagnant (AAPC, 0.48%; P = 0.12). Conclusions: Despite a national decline in esophageal cancer mortality, substantial disparities persist across racial, geographic, and urbanization groups. The dramatic improvement among NH Black populations contrasts with the relative stability in NH White populations and the lack of progress in nonmetropolitan areas. The significant rise in mortality in West Virginia warrants targeted investigation. These findings underscore the critical need for population-tailored strategies to ensure equitable progress in cancer prevention and care.