Temporal trends in mortality involving esophageal cancer with comorbid psychoactive substance-induced mood disorders among adults aged ≥55 years in the United States, 1999–2023: A retrospective CDC WONDER analysis.

Abstract

e16049 Background: Esophageal Cancer (EC) has strong association with mental and behavioral disorders caused by psychoactive substances, and a substantial portion of the U.S population is addicted to these substances. Due to their carcinogenic effects on mucosa, it significantly increases the prevalence of EC particularly, squamous cell carcinoma. Recent studies indicate delay in diagnosis of EC in psychoactive drug users. This study is aimed to analyze the combined effect of EC and psychoactive drug use to characterize national mortality trends with respect to geodemographic variables. Methods: To analyze the national mortality trends associated with EC (ICD-10: C15), and mental and behavioral disorders caused by psychoactive substances (ICD-10: F10-19), we used CDC WONDER database. Age Adjusted Mortality Rate (AAMR) per 1 million of adults aged ≥ 55 years were extracted stratified by gender, ethnicity, and demographic variables. Joinpoint regression software evaluated Annual Average Percentage Change (AAPC) and 95% Confidence Intervals (CI). Results: A total of 63,694 deaths were reported from 1999 to 2023 with overall AAMRs steeply increasing over the study period (AAPC: 11.2*, 95% CI: 9.0 to 13.4). The males exhibit more significant increase in AAMRs (AAPC: 11.2*, 95% CI: 8.9 to 13.5) as compared to females (AAPC: 8.5*, 95% CI: 4.8 to 12.4). Among different ethnicities, Non-Hispanic (NH) Whites experienced largest increase (AAPC: 12.3*, 95% CI: 9.9 to 14.7) whereas NH Blacks and Hispanics had no statistically significant change in mortality. Geographically, the Northeast region demonstrated highest increase in AAMRs (AAPC: 12.6*, 95% CI: 9.1 to 16.2) with inclining trends observed in rural counties (AAPC: 15.1*, 95% CI: 11.7 to 18.6). Conclusions: National mortality trends due to EC and psychoactive substances have substantially increased over the past two decades with most profound increase in males, NH Whites, Northeast region and rural counties. These alarmingly high mortality trends highlight the need for integrated cancer screening and control interventions, and substance abuse prevention strategies particularly targeting high risk populations. Variable Deaths AAMR 1999 AAMR 2023 AAPC (95% CI) Overall 63694 3.9 36.7 11.2*(9.0-13.4) Gender:FemaleMale 1085952835 1.67 11.966.2 8.5*(4.8-12.4)11.2*(8.9-13.5) Census region:NortheastMidwestSouthWest 12269201942082210409 2.444.74 30.856.933.628.1 12.6*(9.1-16.2)10.8*(2.8-19.4)9.9*(6.9-12.8)8.6*(6.0-11.4) Race:HispanicsNH WhitesNH Blacks 1782570275573 5.33.311.4 10.840.823.1 -0.4(-1.8-0.9)12.3*(9.9-14.7)2.7(-2.4-8.1) Urbanization (1999-2020):MetroNon-Metro 3734111641 1999 3.75 2020 34.359.8 11.0*(4.8-17.6)15.1*(11.7-18.6) *Indicates p < 0.05.