Five decades of esophageal cancer mortality in the United States: Shifting patterns by sex, race, age, and income.

301 Background: Esophageal cancer is the sixth leading cause of cancer-related death worldwide and continues to be a major public health concern. In the United States, long-term patterns in mortality have not been fully described, especially across different demographic groups. In addition, socioeconomic differences appear to influence survival, with income playing a role in outcomes. Methods: We used the SEER (Surveillance, Epidemiology, and End Results) database to identify adults with esophageal cancer from 1969 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated and stratified by sex, race (White, Black, and Other), and age >65 years. We also performed survival analyses by income and age. Results: Between 1969 and 2023, more than 615,000 esophageal cancer deaths were recorded in the U.S. Overall mortality rates stayed fairly stable, moving from 3.5 per 100,000 in 1969–1971 to 3.7 per 100,000 in 2019–2023, with a peak of about 4.4 per 100,000 in the early 2000s. Men consistently had much higher mortality than women (3–5 times greater). Black men carried the heaviest burden in the 1970s and 1980s, reaching 18.4 per 100,000, but their rates fell sharply to 4.2 per 100,000 by 2019–2023. White men, on the other hand, showed a gradual rise until the early 2000s (7.9 per 100,000) and then levelled off around 7.0 per 100,000, now exceeding Black men. Mortality among women stayed low and relatively unchanged (1.4–1.8 per 100,000). Trends in adults >65 years showed slower declines, highlighting an ongoing burden in older groups. Survival was consistently better with higher income, especially among younger patients (15–44 years), where the gap was largest. Income-related benefits were present but less pronounced in patients ≥75 years. Conclusions: Esophageal cancer mortality in the U.S. has been steady overall for the past five decades, but the patterns have shifted between demographic groups. The sharp decline among Black men contrasts with the plateau at higher levels among White men, while women have remained at low risk. Differences by sex, race, age, and income suggest that prevention, early detection, and better access to care are still needed. Socioeconomic status plays an especially important role in survival among younger patients, underlining the need for targeted strategies to close these gaps.