National trends and disparities in gallbladder cancer mortality in the United States, 1999–2023.

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e16286 Background: Gallbladder cancer (GBC) is a rare but devastating gastrointestinal malignancy with an incidence of 122,000 new cases annually. GBC can have a varied presentation, and despite medical and surgical advancements, overall prognosis remails poor. Comprehensive, long-term national trends, and disparities in its mortality have not been recently characterized on a multivariable level. Methods: National mortality data for individuals aged ≥45 years in the United States were obtained from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death database for the period 1999–2023. Deaths were identified using International Classification of Diseases (ICD-10 code) C23.0 as the underlying cause of death. Extracted variables included age, sex, race, Hispanic origin, U.S. census region, and level of urbanization. Temporal trends in mortality were evaluated using Joinpoint regression analysis to estimate the average annual percent change (AAPC) and corresponding 95% confidence intervals (CIs). Statistical significance was defined as p value < 0.05. Results: Between 1999 to 2023, a total of 54,454 deaths attributable to GBC were recorded in the United States.The national age-adjusted mortality rate was highest in 1999 (2.323 per 100,000 people) and declined steadily over the study period which reached 1.534 per 100,000 in 2023. This corresponded to a significant overall reduction in mortality, with an average annual percent change (AAPC) of −1.48% (95% CI: −1.64% to −1.31%; p < 0.001). There were significant downward trends in both females (AAPC: −1.65%) and males (AAPC: −1.31%), with mortality rates being consistently higher among females during study period. Racial and ethnic disparities were also very evident. The steepest decline occurred among Hispanic or Latino individuals (AAPC: −2.23%), followed by White individuals (AAPC: −1.87%) and Asian or Pacific Islander individuals (AAPC: −1.38%). In contrast, mortality rates among Black or African American individuals did not demonstrate a statistically significant change over the 25-year period (AAPC: 0.25%). In terms of region, the most significant decline was seen in Census region 1 (Northeast, AAPC: 2.01%, while Region 4 (West) had the least decline (AAPC: 1.02%). All urbanization categories experienced significant declines, with the greatest reduction in Medium Metro areas (AAPC: 2.50%). Conclusions: The significant national decline in GBC mortality since 1999 represents a meaningful progress. However, the absence of a corresponding reduction in mortality among some populations like Black or African American underscores a critical and persistent health inequity. Public Health focused interventions are needed to better understand the underlying drivers of these disparities and to promote equitable reductions in gallbladder cancer mortality.

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