Retrospective CDC-WONDER analysis identifies rising UGI cancer mortality disparities

A retrospective population-based analysis of U.S. death records found that the age-adjusted mortality rate for upper gastrointestinal cancers among adults with metabolic comorbidities increased from 2.0 to 4.2 per 100,000 between 1999 and 2020. Researchers used the CDC WONDER Multiple Cause of Death database and identified 45,086 deaths involving esophageal or gastric cancer with metabolic comorbidities listed as contributing causes. The study, covering the full 1999–2020 period, also found marked differences by age, sex, race and ethnicity, urbanization and state.

The analysis divided the 22-year period into three intervals to describe changes in the overall age-adjusted mortality rate. From 1999 to 2009, the rate rose with an annual percent change of 4.30% (95% confidence interval, 2.97–5.56; p < 0.01). The estimated change from 2009 to 2014 was negative, at −3.50%, but was not statistically significant because the confidence interval included zero (95% CI, −7.45 to 0.61; p = 0.08).

The largest increase occurred from 2014 through 2020, when the annual percent change reached 6.44% (95% CI, 4.35–8.57; p < 0.01). Age-stratified results showed the highest crude mortality among adults aged 85 years and older. Their crude mortality measure increased from 5.2 to 9.3 over the study period, with an annual percent change of 0.55% (95% CI, 0.03–1.08; p = 0.03).

Adults aged 45–54 years had the lowest crude mortality among the groups examined, rising from 0.1 to 0.3, while their annual percent change was 3.53% (95% CI, 2.06–5.02; p < 0.01). Mortality was consistently higher among males than females across the study period. Their overall age-adjusted mortality rates were 2.7 and 1.0 per 100,000, respectively.

These figures describe a population-level difference in the study population; they do not establish why mortality differed between the sexes or whether the reported comorbidities contributed to the difference. The racial and ethnic comparisons identified the highest age-adjusted mortality rate among non-Hispanic Black individuals, at 3.0 per 100,000. The analysis also reported a rate of 2.0 per 100,000 for non-metropolitan areas and 2.7 per 100,000 for the District of Columbia.

These are comparisons of measured mortality in the available records. They should not be read as evidence that race, residential setting or location itself caused the observed differences, or as proof of a time trend within each group. The findings were based on retrospective mortality surveillance rather than a cohort followed for cancer diagnosis, treatment and survival.

The database supplied information on deaths in which esophageal or gastric cancer and metabolic comorbidities were recorded as contributing causes. It did not establish whether metabolic comorbidities caused the cancers, contributed independently to death, or simply coexisted with them. For the same reason, the analysis cannot quantify the incidence of upper gastrointestinal cancer among all patients with metabolic conditions, nor determine the effects of particular treatments on survival.

The retrospective design also means the results describe patterns in recorded death certificates and the population represented in CDC WONDER, rather than the experience of every person living with metabolic comorbidities. The substantial overall increase and the persistent differences among groups are observations, not estimates of future trends or direct evidence of any particular preventive intervention. According to the researchers, the increase in upper gastrointestinal cancer mortality among people with metabolic comorbidities highlights the importance of including these conditions in upper gastrointestinal cancer prevention and survivorship strategies.

That conclusion is consistent with the study’s findings, while the observational design leaves the contribution of individual comorbidities, risk factors and healthcare factors unresolved. Further research would be needed to determine why the age-adjusted mortality rate changed across the three periods and why the largest reported burdens occurred in particular demographic and geographic groups. The results identify a population-level mortality problem recorded in national death data, but they do not show that metabolic comorbidities caused the cancers or that the observed pattern has continued beyond 2020.

Subject of Research: Trends and disparities in U.S. upper gastrointestinal cancer mortality among adults with metabolic comorbidities

Article Title: Trends and disparities in upper gastrointestinal cancer among patients with metabolic comorbidities: a retrospective CDC-WONDER analysis (1999–2020)

Article References: Kashif, Z., Saeed, S., Tariq, H. B., Aftab, H., Aijaz, A., Zahra, I., Hassan, M., Niazi, M., Kashif, I., Mustafa, I. M., Ahmad, B., & Jemjem, B. (2026). Trends and disparities in upper gastrointestinal cancer among patients with metabolic comorbidities: a retrospective CDC-WONDER analysis (1999–2020). BMC Public Health. https://doi.org/10.1186/s12889-026-30022-7

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30022-7

Keywords: upper gastrointestinal cancer, metabolic comorbidities, cancer mortality, CDC WONDER, esophageal cancer, gastric cancer, health disparities, age-adjusted mortality, retrospective study, Trends, disparities, upper