Regional and socioeconomic disparities in Barrett’s esophagus and esophageal cancer mortality in the United States and Texas (1999-2023): A 24-year observational study.

Abstract

e16144 Background: Barrett's esophagus (BE) elevates the risk of esophageal adenocarcinoma (EAC), by 30- fold above that of the general population. This study examines annual trends and demographic/regional disparities regarding EC mortality rates among patients with BE in the United States and its state of Texas from 1999 to 2023, to evaluate public health initiatives, identify areas requiring targeted intervention, and developing better prevention and treatment strategies . Methods: Mortality trends in EAC adults with BE aged ≥25 years were analyzed using the CDC WONDER database, identifying through ICD-10 “Esophageal Malignant Neoplasms” and “Barrett’s Esophagus”. Age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs, were determined using joint point regression analysis. Results: Between 1999 and 2023, 398,216 documented deaths were attributed to BE associated with EAC. The overall AAMR for BE and EAC-related mortality decreased in the US from an adjusted rate (AR) 7.4 in 1999 to (6.5) in 2018 (APC: -0.95%; 95% CI: -2.39% to -0.69%), then it increased to 6.7 in 2023 (APC: -0.06%; 95% CI: -0.75% to 1.82%).In Texas, AAMR for BE and EAC decreased from AR (6.8) in 1999 to (5.7) in 2023 (APC: -0.59%; 95%CI: -0.98% to -0.26%). Males had consistently higher AMMR than females (11.4 vs 2.5). The AAMR in U.S. men decreased from 13.1 in 1999 to 11.4 in 2023. The AAMR in U.S. women decreased from 3 in 1999 to 2.5 in 2023. The non-Hispanic (NH) White population has the greatest AAMR (7.7), followed by the NH American Indian or Alaska Native with AAMR (5.7) and the NH Black or African American (AA) (4.4). The lower-risk population was the Hispanic or Latino population with AAMR (3.4) and NH Asian or Pacific Islanders with AAMR (2.4). AAMR also varied by region (Midwest: 7.7; Northeast: 6.8; South: 6.3; West: 5.8), and non-metropolitan areas had higher AAMR (small metro: 7.8; micropolitan: 8.1; non-core areas: 8.4) than metropolitan areas (large central metropolitan: 5.2; large fringe areas: 6.3). States in the upper 90th percentile of AAMRs were Wyoming, Nebraska, Lowa, South Dakota, Missouri, Ohio, West Virginia, Vermont, Maine with a two-fold increase in AAMRs, compared to states in the lower 10th percentile: California, Texas, Alabama, Georgia, Florida, and New York. Conclusions: Mortality rates from Barrett’s esophagus and esophageal cancer have declined in the United States and Texas over the past two decades, demographic and geographic disparities persist emphasizing the need for further investigation.