Trends in mortalities due to pneumonitis in esophageal cancer in the United States, 1999-2020: A population-based analysis.

Abstract

e16146 Background: Esophageal cancer is an aggressive malignancy with a high global burden and poor survival. In 2020, it accounted for over 0.6 million new cases and approximately 0.54 million deaths worldwide. In the United States, an estimated 22,530 new cases and 16,290 deaths are projected for 2026. Pneumonitis secondary to aspiration pneumonia is a significantly preventable cause of death in these patients. Our retrospective analysis of the CDC WONDER database, spanning 1999-2020, further identifies contributory patterns that warrant targeted future interventions, thereby helping us address aspiration-related issues in these patients. Methods: The data were obtained from the Centers for Disease Control and Prevention (CDC WONDER) database. The age-adjusted mortality rates (AAMR) were adjusted and analyzed per 100,000 people using the 2000 U.S standard population. Annual percentage changes (APCs) were calculated using the Join point regression to identify temporal trends of mortality. Results: From 1999 to 2020, males exhibited higher age-adjusted mortality rates (AAMR) than females (males: 0.274; females: 0.053). The AAMR was higher in whites than in blacks. The AAMR varied across U.S. Census regions, with a slight increase in the Midwest and West, while the AAMR remained in the northeast and south, despite little fluctuation between the study periods. Conclusions: Higher pneumonitis-related mortality in males is attributed to higher incidence of smoking and occupational exposures, higher rate of underlying chronic lung disease, and more advanced cancers requiring aggressive management. Regional and racial differences may be due to unequal access to advanced oncology care and radiation techniques, and healthcare infrastructure. Environmental factors like air pollution, along with socioeconomic barriers, may affect early diagnosis and treatment adherence. Differences in comorbidities and insurance coverage may further influence mortality patterns. Improving outcomes depends on optimized radiation planning, early risk identification, smoking cessation, and close monitoring of high-risk patients, and reducing access-related disparities.