Elnaggar Mohamed, Hassan Ibrahim, Bahnasy Ahmed, Eltaly Hatem, Rezaizadeh Houman
Hospital Medicine department, Hartford, CT, USA.
Faculty of Medicine, Suez Canal, Egypt.
Clin Res Hepatol Gastroenterol. 2025 Sep 22;49(9):102691. doi: 10.1016/j.clinre.2025.102691.
Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation.
We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend.
From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28-4.44) in 1999 to 3.69 (3.63-3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %). Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %).
Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethnicity, and urbanization underscore the need for targeted prevention strategies, early detection initiatives, and enhanced access to specialized care, particularly in rural settings where mortality trends diverge from the national pattern.
食管癌是全球第七大常见癌症，因其总体生存率较低而成为重大的公共卫生问题。尽管出现了包括多模式治疗方法和改进的手术技术在内的治疗进展，但其对全国死亡率趋势的影响仍不明确。了解食管癌死亡率的时间变化以及不同人口统计学和地理亚组之间潜在的差异，对于指导有针对性的干预措施和资源分配至关重要。
我们从疾病控制与预防中心（CDC）的WONDER数据库中获取了1999年至2020年食管癌的死亡率数据，使用国际疾病分类第十版（ICD - 10）编码（C15）表示食管恶性肿瘤。年度死亡率根据2000年美国标准人口进行年龄调整，并按每10,000人和每100,000人表示。分析按性别（男性、女性）、种族/族裔（非西班牙裔黑人或非裔美国人、非西班牙裔白人、西班牙裔）、美国人口普查区域（东北部、中西部、南部、西部）和城市化状况（农村与城市）进行分层。Joinpoint回归确定了具有不同趋势的时期，并估计了年度百分比变化（APC）；平均年度百分比变化（AAPC）总结了总体趋势。
1999年至2020年期间，在超过80亿的人口中记录了374,000例食管癌死亡病例。总体年龄调整死亡率从1999年的4.36（95%置信区间：4.28 - 4.44）降至2020年的3.69（3.63 - 3.75）（AAPC：0.8%）。观察到性别差异，2020年男性死亡率（每100,000人中有6.43例）显著高于女性（每100,000人中有1.38例），尽管两者均呈下降趋势（AAPC分别为0.84%和 - 1.12%）。按种族/族裔划分，黑人或非裔美国人的下降最为明显，从6.61降至2.73（AAPC：3.82%），2018年后下降尤为陡峭（APC：1.58%）。西班牙裔人口从2.54降至1.99，呈适度下降（AAPC：1.32%），而白人人口从4.3降至4.28，变化极小（AAPC：0.05%）。在区域方面，西部下降幅度最大，从4.17降至3.36（AAPC：1.08%），其次是东北部，从4.61降至3.57（AAPC：1.07%），南部从4.23降至3.56（AAPC：0.89%），中西部下降幅度最小，从4.46降至4.37（AAPC：0.31%）。城市地区呈现持续下降趋势（AAPC：1.09%），而农村地区从4.16增至4.52，呈适度上升（AAPC：0.48%）。
1999年至2020年期间，美国食管癌死亡率略有下降，在不同人口统计学和地理亚组中存在显著差异。与其他种族群体相比，黑人或非裔美国人的死亡率显著下降，而农村地区的死亡率出现了令人担忧的上升。性别、种族/族裔和城市化方面的持续差异凸显了制定有针对性的预防策略、早期检测举措以及增加获得专科护理机会的必要性，特别是在死亡率趋势与全国模式不同的农村地区。
