US gastrointestinal malignancies mortality trends among Asian and Pacific Islander populations (1999-2020).

339 Background: Gastrointestinal (GI) cancers are particularly prominent among Asian and Pacific Islander populations and often present at advanced stages, resulting in delayed diagnosis and poor outcomes. This study evaluates gastric cancer mortality trends among Asian population in the United States from 1999 to 2020, stratified by demographic and geographic factors. Methods: We analyzed CDC WONDER Multiple Cause-of-Death data to estimate AAMR for gastrointestinal cancers (ICD-10 C16-21) among Asian and Pacific Islander populations aged ≥25 years. Crude mortality rates and AAMR per 100,000 were calculated using Joinpoint regression, with trends and average annual percent changes (AAPC) stratified by demographic factors (age, sex), geography (urbanization status, census regions, states). Results: From 1999 to 2020, there were 54,226 GI cancer deaths among Asian and Pacific Islander adults aged ≥25 years in the United States. The overall AAMR declined from 38.50 in 1999 to 23.06 in 2020 (AAPC: –2.73; 95% CI, –2.90 to –2.56). Males had higher mortality than females (35.18 vs 23.24), though both showed significant declines (males: AAPC –2.87; 95% CI, –3.08 to –2.67; females: AAPC –2.65; 95% CI, –2.91 to –2.38). Across census regions, the West recorded the highest AAMR (31.32) and the steepest decline (AAPC –2.73; 95% CI, –2.90 to –2.56), while the South had the lowest AAMR (23.39). Nonmetropolitan areas showed higher mortality than metropolitan areas (30.57 vs 23.19) but also a greater decline (AAPC –3.88 vs –2.68). Mortality was lowest among individuals aged 25–34 years (1.09) and highest in those ≥85 years (260.56). At the state level, Hawaii had the highest AAMR (37.37) and Delaware the lowest (15.37). Most deaths occurred at home (39.8%), followed by inpatient medical facilities (34.7%). Conclusions: Despite declining trends, GI cancer mortality among Asian and Pacific Islanders in the U.S. remains disproportionately higher in males, older adults, nonmetropolitan areas, and states like Hawaii, underscoring the need for targeted interventions and equitable care while addressing geographic and age-related inequities. Patterns of end-of-life care, with most deaths occurring at home or in inpatient facilities, further highlight areas for healthcare planning and support. Keywords: Gastrointestinal malignancies, mortality, trends.