Trends in mortality related to anal carcinoma in the United States, 1999–2023: A population-based analysis using CDC WONDER.

Abstract

e15500 Background: Anal carcinoma is an uncommon but increasingly recognized malignancy with established associations to human papillomavirus infection, immunosuppression, and health inequities. While incidence trends have been reported, contemporary national patterns in anal cancer–related mortality over the past two decades remain insufficiently characterized. This study evaluates long-term mortality trends and demographic disparities related to anal carcinoma in the United States from 1999 to 2023. Methods: Mortality data were obtained from the CDC WONDER Multiple Cause of Death database for decedents with anal carcinoma identified using ICD-10 code C21. Age-adjusted mortality rates (AAMRs) and crude rates (CRs) per 1000,000 population were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals. Results: Between 1999 and 2023, 27,223 deaths were attributed to anal carcinoma, corresponding to an overall AAMR of 3.00 per 1000,000 population. Mortality rose gradually between 1999–2018 (APC = 3.14, p < 0.000001) and more rapidly from 2018–2021 (APC = 10.07, p = 0.0187), followed by a slight decline between 2021–2023 (APC = −1.94, p= 0.577), resulting in an overall AAPC of 3.54 (p < 0.000001). Females had higher mortality (AAMR = 3.33) compared to males (AAMR = 2.59). Across ten-year age groups, crude mortality rates increased with advancing age, with the highest rates observed in the 75–84 years (CR = 15.095) and ≥85 years (CR = 24.073) age groups. Black or African American individuals (AAMR = 3.109) and White individuals (AAMR = 3.111) had comparable mortality rates. Regional variation in AAMR was observed (Northeast: 2.77; Midwest: 2.91; South: 3.11; West: 3.14). Residents of Urban areas showed greater AAMR (2.80) than those of rural areas (2.71). Oklahoma had the highest state-level mortality rate (5.09). Conclusions: Anal carcinoma–related mortality in the United States has risen significantly over the past 25 years, with accelerated increases in recent decades and a disproportionate burden among older adults and females. These findings highlight the urgent need for strengthened HPV-related prevention strategies, timely diagnosis, equitable access to oncologic care, and targeted public health interventions to curb rising mortality from this preventable malignancy.