Mortality rates for upper gastrointestinal cancers as a cause or contributing factor in adults aged 45 and older in the United States: A retrospective analysis from 1999-2024.

e16050 Background: Upper Gastrointestinal (UGI) cancers, including esophageal, stomach, and small bowel cancers, have significant health impacts worldwide. This study investigates trends in UGI cancer mortality among adults aged ≥45 years in the U.S. from 1999 to 2024. Methods: Utilizing the CDC WONDER database, death certificate data was analyzed for UGI cancers using ICD-10 codes C15, C16, and C17.0. Age-adjusted mortality rates (AAMRs) were calculated, and trends were assessed using Joinpoint regression in order to determine annual percent changes (APCs) in the mortality rates. Results: Among 7,31,086 UGI cancer-related deaths, AAMR decreased from 28.0 per 100,000 in 1999 to 19.5 per 100,000 in 2024. The decline was most pronounced from 1999 to 2017 (APC -1.65, 95% CI: -1.75 to -1.56), with a slower decrease from 2017 to 2024 (APC -0.80, 95% CI: -1.09 to – 0.28). Gender-specific analysis revealed higher AAMRs for males compared to females, with males showing a decline from 44.8 in 1999 to 32.1 in 2018 (APC -1.68, 95% CI: -1.73 to -1.62) and a further decrease to 30.7 by 2024 (APC -0.96, 95% CI: -1.19 to -0.54). For females, AAMR decreased from 15.7 in 1999 to 10.2 in 2024, with a steeper decline from 1999 to 2014 (APC -2.27, 95% CI: -2.51 to -2.03) followed by a slower rate from 2014 to 2024 (APC -0.79, 95% CI: -1.14 to -0.26). Race/ethnicity-specific trends showed a significant decline in AAMR for Non-Hispanic Black individuals from 1999 to 2015 (APC -3.73, 95% CI: -3.96 to -3.55), with a continued decrease until 2024 (APC -2.37, 95% CI: -2.81 to -1.67). Non-Hispanic Asian or Pacific Islander groups also experienced a substantial decrease in AAMR from 1999 to 2020 (APC - 3.09, 95% CI: -3.75 to -1.72), while trends for other racial/ethnic groups showed variable rates of decline. Geographically, the Northeast had the highest AAMRs and exhibited a consistent decline from 1999 to 2024 (APC -2.00, 95% CI: -2.10 to -1.91). Mortality rates in nonmetropolitan areas were higher compared to metropolitan areas, though both regions experienced similar declining trends. Conclusions: The study reveals a notable decline in UGI cancer mortality rates over the past two and a half decades, with important variations based on gender, race, and geographic region. While overall trends are promising, ongoing disparities highlight the need for targeted public health strategies to address these inequities and improve cancer outcomes.