Temporal trends in metabolic syndrome–associated mortality among patients with upper gastrointestinal cancers, 1999–2020: A CDC WONDER analysis.

Abstract

e16062 Background: Upper gastrointestinal (UGI) cancers remain a major cause of cancer mortality in the United States. Metabolic disorders, including diabetes, obesity, dyslipidemia, and hypertension, may worsen prognosis and contribute to disparities in outcomes. However, national mortality trends assessing UGI cancer deaths in the context of metabolic comorbidities are not wellcharacterized. Methods: A retrospective population-based analysis was conducted using the CDC WONDER Multiple Cause of Death database (1999–2020). Deaths with oesophageal or gastric cancer as the underlying cause and metabolic disorders as contributing causes were included. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percent change (APC) were calculated. Joinpoint regression was done and analyses were stratified by age, sex, race/ethnicity, urbanisation, and state. Results: From 1999 to 2020, 45,086 deaths occurred among adults with UGI cancers and metabolic comorbidities. Overall AAMRs increased from 2.0 to 4.2 per 100,000, with a significant rise from 1999 to 2009 (APC 4.30%; 95% CI, 2.97–5.56; p < 0.01), a modest decline from 2009 to 2014 (APC −3.50%; 95% CI, −7.45 to 0.61; p = 0.08), and a sharp increase from 2014 to 2020 (APC 6.44%; 95% CI, 4.35–8.57; p < 0.01). Age-stratified analysis demonstrated the highest crude mortality among adults aged ≥85 years (5.2 to 9.3; APC 0.55%; 95% CI, 0.03–1.08; p = 0.03) and the lowest among those aged 45–54 years (0.1 to 0.3; APC 3.53%; 95% CI, 2.06–5.02; p < 0.01). Males consistently exhibited higher mortality than females (overall AAMR 1.7 vs. 1.0), with significant increases among males from 1999–2006 (APC 5.95%; 95% CI, 3.60–8.35; p < 0.01) and 2017–2020 (APC 7.46%; 95% CI, 2.19–13.00; p < 0.01). Racial disparities were observed, with the highest AAMR among Non-Hispanic (NH) Black individuals (3.0), followed by Hispanics (2.2; APC 1.36%; 95% CI, 0.71–2.01; p < 0.01), NH Asian or Pacific Islanders (2.0; APC −0.47%; 95% CI, −1.39 to 0.45; p = 0.29), and NH Whites (1.6; APC 5.43%; 95% CI, 3.11–7.81; p < 0.01). By urbanisation, micropolitan areas demonstrated the highest AAMR (2.0; APC 2.46%; 95% CI, 1.81–3.11; p < 0.01), followed by large metropolitan and non-core areas (1.9 each), while large fringe metropolitan areas had the lowest AAMR (1.5). The District of Columbia (2.7), Mississippi (2.6), California (2.5), Hawaii (2.5), Nebraska (2.5), and Ohio (2.5) had state-level AAMRs above the 90th percentile (≥2.49 per 100,000). Conclusions: UGI cancer mortality associated with metabolic comorbidities increased substantially from 1999 to 2020, with pronounced disparities by age, sex, race, urbanization, and state. These findings underscore the need for targeted prevention strategies addressing metabolic health and geographic inequities to reduce UGI cancer mortality.