Two Decades of Disparity: Racial and Geographic Trends in Colorectal Cancer Mortality in the United States (2000-2020).

Introduction Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States. While overall mortality has declined due to improvements in screening and treatment, persistent disparities by race, sex, and geography raise concerns about equitable healthcare access. Objective The objective of the study is to assess long-term trends in CRC mortality in the United States from 2000 to 2020, with a focus on racial, sex-based, and geographic disparities. Materials and methods A retrospective observational study was conducted using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. CRC mortality was identified using International Classification of Diseases, 10th Revision (ICD-10) codes C18-C21. Data were stratified by race, sex, and U.S. state. Age-adjusted death rates per 100,000 population were calculated and averaged over the 20-year period. Poisson regression analysis was conducted to assess the independent association of race and sex with mortality. Results were visualized by subgroup and geographic distribution. Results Black men had the highest national CRC mortality rate (17.7/100,000), followed by White men (15.3/100,000). Men consistently experienced higher mortality than women across all racial groups. Asian/Pacific Islander and American Indian or Alaska Native (AI/AN) populations had the lowest age-adjusted rates. Southern and Midwestern states demonstrated the highest average state-level mortality rates. Poisson regression confirmed that White (rate ratio (RR): 2.46), Black (RR: 2.24), and Asian (RR: 1.13) individuals had higher mortality than AI/AN individuals. Men had 9.2% higher mortality than women (RR: 1.09). All results were statistically significant (p < 0.001). Conclusion Significant disparities in CRC mortality persist across racial, sex, and regional lines in the United States. Black men experience the highest age-adjusted mortality, and overall rates are consistently higher among men than women. States in the South and Midwest carry the greatest burden, underscoring the need for geographically targeted interventions. These findings highlight the urgency of expanding access to screening, addressing systemic inequities, and implementing risk-based public health strategies in underserved communities.