Introduction
Gastric cancer remains one of the leading causes of death internationally and a major health concern in the United States (US). To develop better prevention strategies, this study quantifies trends in gastric cancer related mortality, stratified by age, sex, region, urbanity, and race over two decades.
Aims & Methods
Our study used the CDC WONDER database to analyze death certificates from 1999 to 2022 across the U.S. ICD codes C16.0-C16.9 were used to identify the relevant cases. Demographic variables such as sex, race, age, urban-rural classification, and census regions were analyzed. Trends in AAMR were assessed using the Joint Point Regression Program to determine annual percentage changes (APC).
Results
Overall mortality related to malignant stomach neoplasms in the US declined significantly (Table 1) from 79.26 (1999) to 44.81 (2022), with notable periods of steep decrease between 1999–2006 (APC -3.51, 95% CI: -5.16 to -2.78) and 2006–2018 (APC -2.27, 95% CI: -3.55 to -1.83). Men consistently exhibited higher mortality rates than women (overall men: 81.14 vs women: 42.10). Men experienced an initial significant drop from 113.45 to 78.68 (1999–2009, APC -3.55), followed by a slower decrease till 2022 (APC -2.22). Women's mortality showed an initial sharp decline (1999–2008, APC -3.11), then a modest reduction from 2008–2018 (APC -1.96), plateauing thereafter.
Racially, Non-Hispanic (NH) Black individuals exhibited the highest mortality (109.37), followed by NH Asians/Pacific Islanders (102.47), Hispanic/Latino (91.93), NH American Indian/Alaskan Natives (78.21), and NH White (44.85). NH Blacks demonstrated a marked initial decrease (159.46 to 119.13 by 2017) then plateaued. NH Whites showed a continuous decline (1999–2018), slowing post-2018. Hispanics had two significant declining periods (1999–2011, APC -2.82; 2011–2022, APC -1.56), whereas NH Asians and NH American Indians steadily declined throughout.
Mortality by age was highest among older adults (202.46), followed by middle-aged (60.58) and young adults (40.55). Older adults had two notable decreasing phases (1999–2009, APC -3.56; 2009–2018, APC -2.89), with slower decline afterward. Middle-aged adults showed an initial steep decline (1999–2005, APC -3.65), followed by gradual reduction (2005–2022, APC -0.79). Young adults exhibited minimal, non-significant declines throughout.
Regionally, the Northeast showed highest mortality (64.78), followed by West, South, and Midwest. Both metropolitan and non-metropolitan areas saw significant mortality reductions, with non-metropolitan areas consistently having higher rates overall.
| Year Interval | APC (95% CI) |
|---|
| Overall, 1999–2006 | -3.5122* (-5.1671 to -2.7897) |
| Overall, 2006–2018 | -2.2729* (-3.5503 to -1.8336) |
| Men, 1999–2009 | -3.5576* (-4.0308 to -3.2516) |
| Men, 2009–2022 | -2.2237* (-2.4386 to -1.9148) |
| Women, 1999–2008 | -3.1199* (-4.336 to -2.566) |
| Women, 2008–2018 | -1.9683* (-3.2828 to -1.529) |
| Middle age, 2005–2022 | -0.7941* (-1.0586 to -0.4509) |
| Old age, 1999–2009 | -3.5689* (-4.6879 to -2.9814) |
| Old age, 2009–2018 | -2.8971* (-3.7364 to -2.2656) |
Table 1. Annual Percent Change (APC) in mortality rates by selected demographics, 1999–2022.
APC values are presented with 95% confidence intervals (CI). Asterisk (*) indicates statistically significant APC values (p < 0.05).
Conclusion
Gastric carcinoma has poor prognosis, and although the general trend is decreasing across all socio-demographic areas, further research is required for targeted interventions and health policies for populations at high risk of dying.
References
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Disclosure
No conflicts of interest to disclose.