Trends in mortality involving esophageal cancer and alcohol-related behavioral disorders in the United States, 1999–2023.

Abstract

e16071 Background: Esophageal cancer carries one of the highest mortality rates among solid tumors, while alcohol-related behavioral disorders (ARBD) represent a growing public health concern. Alcohol exposure is a known risk factor for esophageal cancer, yet national trends in mortality involving both conditions remain poorly defined. We evaluated long-term mortality patterns and disparities among U.S. deaths involving esophageal cancer and ARBD. Methods: Mortality data from the CDC WONDER Multiple Cause of Death database (1999–2023) were analyzed. Deaths involving esophageal cancer and ARBD were identified using ICD-10 codes. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated overall and stratified by sex, age, race/ethnicity, U.S. census region, and urbanization. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Results: A total of 74,832 deaths involving both esophageal cancer and ARBD were identified. Overall AAMR increased from 0.12 in 1999 to 1.37 in 2023, representing a significant upward trend (AAPC 6.1%, p < 0.001). Mortality rose sharply between 2003 and 2018 (APC 9.4%, p < 0.001), followed by a modest decline after 2019. Males consistently had higher mortality than females (peak AAMR 2.54 vs 0.47). Older adults accounted for the highest absolute mortality, while middle-aged adults experienced the fastest relative increases (AAPC 7.3%, p < 0.001). Mortality rates were highest among White individuals, residents of the Midwest, and non-metropolitan populations. Conclusions: Mortality involving esophageal cancer and alcohol-related behavioral disorders has increased substantially in the United States over the past two decades, with pronounced disparities by sex, age, geography, and urbanization. These findings highlight a growing high-risk population and underscore the need for integrated cancer prevention, alcohol-use screening, and behavioral health interventions alongside oncologic care. Average annual percent change (AAPC) in mortality involving esophageal cancer and alcohol-related behavioral disorders, United States. Subgroup AAPC (%) 95% CI P value Overall 12.8 10.2–15.5 <0.001 Male 12.7 10.0–15.6 <0.001 Female 11.0 8.3–13.6 <0.001 Age ≥65 years 13.0 10.0–16.1 <0.001 White 14.2 11.8–16.8 <0.001 Black 6.5 3.9–9.2 <0.001 Midwest 12.6 3.6–22.5 0.005 Northeast 16.0 11.0–21.3 <0.001 Non-metropolitan 16.2 12.6–20.0 <0.001