P4918 - Temporal Trends of Esophageal Cancer-Associated Mortality Among Individuals With Hypertension in the United States from 1999-2023: A Nationwide Analysis Using the CDC WONDER Data

Rizwana Noor, ¹, Muhammad Sheraz Hameed, MBBS², Naga Praneeth Vakkalagadda, MD³, Shamikha Cheema, MBBS⁴, Sadaf Iftikhar, MBBS⁵, Muhammad Hammad ul HU. Hassan, MD⁶, Rithish Nimmagadda, MBBS⁷
1Khyber Medical College, Peshawar, North-West Frontier, Pakistan; 2Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan; 3University of Alabama at Birmingham Heersink School of Medicine, Montgomery, AL; 4King Edward Medical University, Lahore, Punjab, Pakistan; 5Akhtar Saeed Medical and dental college, Lahore, Punjab, Pakistan; 6South Brooklyn Health, Brooklyn, NY; 7One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY

Introduction: Esophageal cancer is the sixth leading cause of cancer-related deaths in the U.S, with a 5-year survival rate of just 20% despite treatment advances. Known risk factors include smoking, alcohol use, and GERD. Emerging evidence suggests hypertension affects nearly half of U.S. adults and may contribute to cancer progression via vascular or inflammatory pathways. However, its link to esophageal cancer mortality remains under-explored, limiting targeted prevention efforts.

Methods: We analyzed CDC WONDER data (1999–2023) on adults ≥ 45 years with esophageal cancer (ICD-10: C15) as the underlying cause of death and hypertension (ICD-10: I10–I15) as a contributing cause. Mortality rates (crude and age-adjusted per 100,000) were stratified by age, sex, race/ethnicity, region, and urbanization. Join-point regression was used to assess trends, reporting APC and AAPC with 95% CIs (p < 0.05).

Results: Between 1999 and 2023, 25,421 U.S. adults with hypertension died from esophageal cancer. The age-adjusted mortality rate (AAMR) rose from 1.24 to over 4 per 100,000. The steepest rise occurred from 1999–2001 (APC: 22.1%), with an overall annual increase (AAPC) of 5.31%. Males (AAMR: 4.49) had higher rates than females (1.09). The highest crude mortality was among those ≥85 years (26.24/100,000), and the lowest in the 45–54 age group (0.89/100,000). Rural areas had higher AAMR (3.05) than urban (2.63). Non-Hispanic Blacks had the highest mortality (3.45), followed by Whites (2.92) and Asians/Pacific Islanders (1.46). The South region saw the greatest burden. Oklahoma had the highest AAMR (4.44), while California had the most deaths (2,468).

Discussion: Esophageal cancer mortality in patients with hypertension has shown a rising trend in U.S. adults over the past two decades, with particularly high rates among males, non-Hispanic Whites, and residents of urban and Southern regions. These findings suggest a potential vascular-oncologic link, possibly mediated by vascular endothelial growth factor (VEGF-A), which connects hypertension-induced endothelial dysfunction with tumor angiogenesis. Further research is warranted to explore causal mechanisms and develop targeted prevention strategies. Focused screening and resource allocation for high-risk groups may help reduce esophageal cancer–related mortality.


Figure: Figure 1: Updated esophageal cancer associated mortality among hypertensive adults in the United States (2023)


Figure: Figure 2: Esophageal cancer-related motality in hypertensive U.S. adults: a 25 year portrait

Disclosures:
Rizwana Noor indicated no relevant financial relationships.
Muhammad Sheraz Hameed indicated no relevant financial relationships.
Naga Praneeth Vakkalagadda indicated no relevant financial relationships.
Shamikha Cheema indicated no relevant financial relationships.
Sadaf Iftikhar indicated no relevant financial relationships.
Muhammad Hammad ul Hassan indicated no relevant financial relationships.
Rithish Nimmagadda indicated no relevant financial relationships.

Rizwana Noor, ¹, Muhammad Sheraz Hameed, MBBS², Naga Praneeth Vakkalagadda, MD³, Shamikha Cheema, MBBS⁴, Sadaf Iftikhar, MBBS⁵, Muhammad Hammad ul HU. Hassan, MD⁶, Rithish Nimmagadda, MBBS⁷. P4918 - Temporal Trends of Esophageal Cancer-Associated Mortality Among Individuals With Hypertension in the United States from 1999-2023: A Nationwide Analysis Using the CDC WONDER Data, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.