Demographic and regional trends of gastrointestinal (GI) cancer mortality in adolescents and young adults (AYA) in the US, 1999-2019.

Abstract

786 Background: There is an alarming rise in incidence of GI cancers in AYAs that face unique social challenges in navigating their healthcare and receiving guideline-concordant care. There is limited data on mortality trends in this understudied group. We investigated age-adjusted mortality rates (AAMRs) in young adults with GI cancer. Methods: We utilized the CDC WONDER database to analyze deaths among young adults aged 15 to 44 years from GI cancer (ICD 15-26) from 1999 to 2019. We calculated AAMRs per 100,000 and stratified by sex, race/ethnicity, census, and urban metro (population >1,00,000), medium/small (50,000 – 999,999) or rural area (<50,000) per NCHS Classification Scheme. We used Joinpoint regression software (v4.9) to establish annual percentage change (APC) trends. Results: Between 1999 and 2019, there were 73,954 deaths from GI cancer in young adults (39% female, 16% Hispanic, 20% non-Hispanic Black, 16% rural, 42% Southern-located, 52% colorectal, and 17% each pancreatic, hepatobiliary, and gastric cancers). Overall AAMR over study period was 3.3. Among subgroups, the AAMR was higher in men (3.9), non-Hispanic Black adults (4.6), and rural areas (3.7). Time analysis by year showed overall stability or slight decrease in AAMRs between 1999-2009, followed by an increase from 2009-2019. This was especially notable in Hispanic individuals. Earlier increases in AAMR were noted in rural (since 2004) and Midwestern (since 2001) locations. Highest AAMRs were noted in Southern states (Mississippi, Kentucky, West Virginia, and Alabama). Compared to our younger cohort, older adults (45+) had expectedly higher but recorded significantly better AAMR improvements during study period. Conclusions: Mortality rates for AYAs with GI cancers remained relatively stable from 1999 to 2009, but have since risen, with significant sociodemographic and regional variation. These data highlight the need to better understand risk factors (diet, environmental, and other), screening trends, and variation in receipt of guideline-concordant care to ensure appropriate and equitable risk reduction and cancer management in AYAs.[Table: see text]