Racial and geographical disparities in oesophageal cancer incidence, mortality and county-level risk factors in the state of Mississippi between 2003 and 2019: a descriptive analysis.

Background: Oesophageal cancer is one of the most aggressive cancers. The aim was to describe the disparities in oesophageal cancer incidence and mortality, and county-level factors in the state of Mississippi from 2003 to 2019 by sex, race, and geolocation.

Methods: This study used data from the Mississippi Cancer Registry, linked to county-level data from the Behavioral Risk Factor Surveillance System, the American Community Survey, and the Institutes for Health Metrics and Evaluation. We estimated age-standardised incidence (crude ASR) and mortality rates (crude AMR), mortality-incidence rate ratio and average annual percent change (AAPC) in rates by sex, race, and geolocation, using the Joinpoint Software V.5.0. We further calculated relative risks for oesophageal cancer using age-adjusted quasi-Poisson regression for each county-level factor including smoking, obesity, college degree completion, unemployment rate and median household income ranking within the state.

Results: Between 2003 and 2019, a total of 2737 oesophageal cancer cases and 2259 oesophageal cancer deaths occurred in Mississippi. Black men had the greatest reduction in oesophageal cancer incidence and mortality despite high rates (crude ASR=10.5, crude AMR=7.3 per 100 000; AAPC=-3.7%, p<0.001 and AAPC=-4.9%, p<0.001). The reduction was largely driven by decreases in the non-Delta region (AAPC=-4.2%, p<0.001), while incidence rate remained high among Black men in the Delta region (crude ASR=15.4 per 100 000, AAPC=-1.8%, p=0.3). The rates among White men were relatively stable (crude ASR=8.5, crude AMR=7.6 per 100 000; AAPC=0.18%, p=0.7, AAPC=-0.4%, p=0.6). County-level smoking prevalence (in quartile, p=0.02) was significantly associated with oesophageal cancer incidence.

Discussion: This study highlights the importance of targeted interventions to address the persistent high incidence rate of oesophageal cancer among Black men in the Delta region.