Examining the link between tobacco use and gastric cancer mortality: A U.S. population-based perspective (1999–2023).

324 Background: Gastric cancer (GC) remains a major cause of cancer-related mortality, influenced by diverse risk factors including infection, diet, and genetics. Tobacco use is a notable modifiable contributor, promoting carcinogenesis through chronic mucosal damage. However, the national mortality burden of tobacco-associated GC remains inadequately characterized. This study aims to assess long-term mortality trends of tobacco-associated GC among U.S. adults aged ≥25 years. Methods: A retrospective cross-sectional analysis was performed using the CDC WONDER Multiple Cause of Death database (1999–2023). Adults aged ≥25 years with gastric cancer (ICD-10: C16) and tobacco use disorder (ICD-10: F17) were included. Age-adjusted mortality rates (AAMRs) per 100,000 were computed for the overall population and subgroups stratified by sex, race/ethnicity, census region, and urbanization. Crude mortality rates (CMRs) were used for age-specific comparisons. Joinpoint regression identified significant temporal changes, reporting annual percent change (APC) and average annual percent change (AAPC). Results: A total of 17,357 deaths were attributed to tobacco-associated GC (AAMR: 0.34), with males contributing 13,099 deaths (AAMR: 0.58) and females 4,258 (AAMR: 0.15). AAMR increased over time [AAPC: 4.60%; 95% CI: 3.11–6.18]. Males and females exhibited similar trends [AAPC: 4.59% and 4.58%, respectively]. The highest increases were seen in males (APC: 23.29%; 2003–2006) and females (APC: 14.75%; 2003–2008). Non-Hispanic Whites had the steepest rise [AAMR: 0.32], followed by Black/African Americans [AAMR:0.56], and Hispanics [AAMR:0.30]. The Midwest region showed the greatest increase [AAMR: 0.45], and rural areas experienced higher growth [AAMR: 0.43] than urban ones [AAMR: 0.30], with a peak in urban areas between 2003–2005 (APC: 35.49%). Conclusions: Tobacco-associated GC mortality has risen notably across the U.S., especially among males, non-Hispanic Whites, rural residents, and those in the Midwest. These findings highlight the urgency of enhanced tobacco cessation, early GC screening, and focused public health strategies for at-risk populations. Deaths and age-adjusted mortality rates (AAMRs) per 100,000 for trends related to gastric cancer and tobacco use disorder in adults in the United States between 1999 and 2023. Variable Deaths (n) Average AAMR Overall 17,357 0.34 Sex Female 4,258 0.15 Male 13,099 0.58 Race/Ethnicity NH Blacks 2,843 0.56 NH Whites 13,805 0.32 Hispanics 1,341 0.30