Non-melanoma skin cancer–related mortality in the United States: A 25-year CDC WONDER analysis.

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9580 Background: Non-melanoma skin cancer (NMSC), including basal cell and squamous cell carcinoma, is the most common malignancy worldwide, with rising incidence due to ultraviolet exposure and aging populations. Analyzing two decades of CDC WONDER data provides insights into mortality disparities and geographic variation. Methods: Using the CDC WONDER database for adults aged ≥25, we analyzed age-adjusted and crude mortality rates (AAMRs and CMRs) per 100,000 for NMSC (ICD-10 C44.0 to C44.9) by year, sex, race/ethnicity, and geography. Joinpoint regression (version 5.4) estimated average annual percentage change (AAPC) and annual percentage change (APC) with 95% confidence interval (CIs). Results: From 1999–2023, NMSC caused 118,792 deaths (female: 36,921; male: 81,871), most occurring at the Decedent's home (37.7%). The AAMR rose 41% from 1.92 in 1999 to 2.72 in 2023 (AAPC: 1.55%; p<0.001), with significant increases in 2005–2019 (APC: 1.88, 95% CI: 1.45 to 2.30) and 2019–2023 (APC: 4.92, 95% CI: 2.78 to 7.09). Adults ≥65 had the highest CMR (8.59), rising 1.57% annually (p<0.001). Men consistently had higher AAMR about three times that of women in 1999 (3.24 vs. 1.03), and the gap remained in 2023 (4.35 vs. 1.50). Non-Hispanic (NH) Whites had the highest AAMR, rising 2.06% annually (p<0.001), while NH Asians or Pacific islanders had the lowest with a slight decline (-0.19%; p=0.81). Regionally, the West had the fastest rise in AAMR at 1.68% annually (p<0.001), while the Midwest had the slowest at 1.24% (p<0.001). Mortality in rural areas (AAMR: 2.35) rose faster (1.41%; p<0.001) than in urban populations (AAMR: 1.93; 0.80%). Oklahoma and West Virginia ranked highest in the top 90th percentile. Conclusions: Mortality from NMSC has risen in the United States over the past two decades. However, significant demographic and geographic disparities in mortality continue, emphasizing the need for equitable healthcare access and targeted interventions, particularly among males, NH Whites, and high-burden states and regions. Deaths and AAPC for trends related to non-melanoma skin cancer from 1999 to 2023. Variable Deaths AAPC (1999-2023) with CI Overall 118,792 1.55 (1.01 to 2.09) Male 81,871 1.29 (0.71 to 1.87) Female 36,921 1.54 (1.10 to 1.99) NH White 108,523 2.06 (1.54 to 2.60) NH Black 4,797 -0.67 (-1.74 to 0.40) Hispanic 3982 0.76 (0.48 to 2.02) NH Asians 1,105 -0.20 (-1.87 to 1.51) Midwest 25,260 1.25 (0.66 to 1.83) West 27,192 1.54 (1.03 to 2.05) South 46,442 1.64 (1.12 to 2.17) Northeast 19,898 1.69 (0.90 to 2.49)

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