Mortality trends due to endometrial cancer in the United States: A retrospective analysis from 1999-2020.

Abstract

e17628 Background: Endometrial cancer (EC) is the most common gynecological cancer in the United States (US). The lifetime risk of being diagnosed with EC for women is 1 in 40. According to the American Cancer Society, around 67,880 new cases of uterine cancer are estimated to be diagnosed in the US in 2024, and about 13,250 women are expected to die from it. Since the mid-2000s, there has been an increase in death rate by 1.7% per year. Previous data indicates that mortality rates due to EC are disproportionately higher in Black American women compared to women from other ethnic groups. This disparity may be attributed to factors such as limited awareness of symptoms, reduced access to timely treatment, and delayed diagnosis. In light of this, we conducted a retrospective analysis to investigate the demographic and regional trends in EC-related mortality among women 15–84 years of age in the US, ranging from 1999 to 2020. Methods: Using the data from the Center for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) we identified crude and age-adjusted mortality rates (AAMR) per 100,000 individuals. We used Joinpoint regression to examine the changes in AAMR through annual percentage changes (APCs). Results: Between 1999 and 2020, 87,286 deaths were reported due to EC. A gradual decline in overall AAMR was observed from 1999 to 2013 (APC: -0.29), followed by a marginal rise from 2013 to 2020 (APC: 8.21). Among all ethnicities, non-Hispanic African Americans (4.7) and NH Asians or Pacific Islanders (1.8) were found to have the highest and the lowest overall AAMRs, respectively. A prominent disparity in AAMR was observed among states, with values ranging from 1.69 in Nevada to 5.03 in the District of Columbia and 4.41 in Vermont. States in the upper 90th percentile of endometrial cancer-related deaths included the District of Columbia, Vermont, Iowa, Nebraska, New Hampshire, Wisconsin, and Maine. The highest overall increase in AAMR was observed in Oregon (182.9%), and the largest overall decrease was observed in Nebraska (-3.6%). Across census regions, the highest AAMR was observed in the Northeast (3.2), followed by the Midwest (3.15), the South (2.57), and the West (2.5). No striking differences were noted in the trends of different metropolitan areas. Most deaths occurred at the decedents’ homes (38.7%), followed by medical facility ー inpatient (29.7%). Conclusions: After an initial period of slow decline from 1999 to 2013, our study results demonstrate an upward spike in the AAMR for EC-related mortality trends amongst females in the US. AAMRs were highest among the African American population and those residing in the Northeastern region. Continued efforts towards surveillance and targeted screening along with risk factor identification can greatly improve the overall clinical outcomes as well as the mortality rates associated with endometrial carcinoma.