Trends in gastric cancer mortality by subsite (cardia vs. non-cardia) and racial disparities from 1999-2023.

Abstract

298 Background: Gastric cancer is uncommon in the U.S. but has a poor prognosis. We compared mortality trends for cardia vs. non-cardia gastric cancer. Methods: Data from CDC WONDER for adults aged ≥25 years were analyzed. ICD-10 C16.0 (cardia) and C16.1-C16.6, C16.8, C16.9 (non-cardia) were used. AAMRs were calculated per 100,000 population stratified by sex and race. Average Annual Percentage Change (AAPC) and Annual Percentage Change (APC) were analyzed using joinpoint regression. Results: Cardia gastric cancer accounted for 23,871 deaths, while non-cardia subsites accounted for 288,451 deaths. The cardia AAMR changed from 0.48 in 1999 to 0.52 in 2023, reflecting a decline to 2013 (APC -1.08, p=0.03) followed by a significant rise between 2013 and 2023 (APC: 3.11, p=0.003; AAPC: 0.63, p=0.07). In contrast, non-cardia AAMR showed a sharp drop from 7.47 in 1999 to 3.92 in 2023, with steeper declines 1999-2008 (APC -3.42) and continued decreases 2008-2023 (APC -2.28; both p<0.001; AAPC -2.71, p<0.001). By sex, men had higher rates for both subsites; cardia in men was flat overall (AAPC -0.06; p=0.83), while non-cardia fell significantly in both men (AAPC -3.13) and women (−2.37; both p<0.001). By race, cardia increased in NH White after 2013 (APC 3.27, p<0.001) and stable in Blacks; non-cardia declined in both groups (White AAPC -2.67; Black -3.32, both p<0.001) but remained higher in Blacks by 2023 (6.74 vs 3.46). Conclusions: Cardia mortality has turned upward since the mid-2010s (particularly among NH Whites, with higher levels in men), whereas non-cardia mortality continues to decline across sex and race. Persistent gaps between men > women for both subsites and higher non-cardia rates in Blacks vs Whites underscores the need for subsite-specific, equity-focused prevention and early detection. Age-adjusted mortality rates (AAMRs) per 100,000 for trends related to gastric cancer mortality by subsite (cardia vs. non-cardia) and racial disparities among United States adults between 1999 and 2023. Variables Cardia Non-cardia AAMR (95% CI) 1999 AAMR (95% CI) 2023 AAMR (95% CI) 1999 AAMR (95% CI) 2023 Overall 0.48 (0.44-0.51) 0.52 (0.49-0.55) 7.47 (7.35-7.60) 3.92 (3.84-4.00) Sex  Male 0.84 (0.78-0.91) 0.84 (0.79-0.89) 10.54 (10.3-10.78) 4.97 (4.84-5.1)  Female 0.16 (0.13-0.18) 0.19 (0.17-0.22) 5.37 (5.23-5.51) 3.11 (3.02-3.21) Race  NH Whites 0.51 (0.47-0.55) 0.56 (0.53-0.59) 6.44 (6.32-6.57) 3.46 (3.38-3.54)  NH Blacks 0.27 (0.19-0.36) 0.25 (0.20-0.32) 15.5 (14.87-16.13) 6.74 (6.44-7.05)