Uterine cancer mortality and demographic disparities in the United States in relation to female obesity.

Abstract

e17616 Background: Uterine Cancer is the sixth most common cause of death in women. The incidence and mortality rates of uterine cancer have increased 0.7% and 1.1% per year respectively over the past two decades. We evaluated long-term mortality trends across age, race/ethnicity, urbanization and geography using national surveillance data. Additionally, we assessed recent trends in female obesity prevalence to provide insight into observed mortality patterns. Methods: We used the data from CDC WONDER from 1999-2020 to calculate age-adjusted mortality rates stratified by age, sex, race and urbanization. Uterine Cancer deaths were identified using ICD 10 codes C54-C55 and obesity was identified using ICD code E66. Temporal trends were assessed using Joinpoint regression to estimate annual percent changes (APC) and average annual percent change (AAPC) with 95% confidence interval. Results: Overall joinpoint regression identified a single inflection point in 2009. Mortality declined between 1999 and 2009 (APC -0.46%, 95% Cl -0.76 to -0.16; P = 0.005) followed by a significant increase from 2009-2020 (APC 1.53%, 95% Cl 1.32 -1.74; P <0.001), resulting in an overall rise in mortality (AAPC 0.58%, 95% Cl 0.41-0.74; P <0.001). Age stratified analysis shows sustained increase among women aged 25-64 years throughout the study period (AAPC range 1.39% -1.96%; P <0.001). Among women aged 45-84 years, inflection points occurred between 2005 and 2009, after which mortality increased significantly. A marked rise was seen in women aged 65-74 years after 2008 (APC 2.33%; P <0.001), while those aged 75-84 years had increase in mortality after 2009 (APC 1.40%; P <0.001). Racial disparities were evident with increasing mortality among Asian and Pacific Islander, Hispanics, Black and White women (AAPC 2.15%, 1.14%, 0.85%, 0.44% respectively; all P <0.001). Urbanization showed significant increase post 2009 across central, large fringe and medium metropolitan areas (AAPC range 0.40%- 0.80%; P <0.006). Geospatial mapping shows higher mortality clustering in parts of Midwest, Northeast and Southeast regions. In parallel, analysis of female obesity prevalence demonstrated a significant increase post 2010 (APC 6.38% , Cl 5.24-7.53; P <0.0001), with a greater increase noted in recent years, indicating a marked acceleration in the burden of obesity in past few years. Conclusions: This mortality burden likely reflects the obesity epidemic and increasing metabolic disease, resulting in estrogen exposure and insulin resistance, compounded by delayed diagnosis in the absence of effective screening. A shift towards aggressive histologic subtypes and persistent racial, socioeconomic and geographic inequities further amplify these trends. Hence, there is a need for equitable access to guideline-based care and further research.