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Small Bowel Cancer-Related Mortality in the United States, 1999 to 2024: A CDC WONDER Trend and Forecasting Analysis
Arkadeep Dhali1,2, Jyotirmoy Biswas3, Ali Shan Hafeez4
1Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield.
Objectives:
Small bowel malignancies are rare, but mortality trends remain incompletely characterized. We assessed national small bowel cancer-related mortality trends in the United States.
Methods:
This retrospective population-based study used the CDC WONDER database. Deaths with small bowel malignancy listed as an underlying or contributing causewere queried. Analyses covered 1999 to 2024, except urbanization through 2020. Age-adjusted mortality rate (AAMR) per 100,000 were examined overall and by sex, age, census region, state, urbanization, and place of death. Joinpoint regression estimated annual percent change (APC)/average annual percent change (AAPC); autoregressive integrated moving average (ARIMA) models forecasted AAMRs.
Results:
AAMRs were stable from 1999 to 2012 (APC: -0.30), then increased significantly from 2012 to 2024 (APC: 2.47; 95% CI: 1.91-3.39), with a significant overall increase (AAPC: 1.02; 95% CI: 0.80-1.26). Males had higher mortality than females, with significant overall increases in both sexes. Older adults drove the age-related burden, rising significantly from 2012 to 2024 (APC: 2.91; 95% CI: 2.34-3.86; AAPC: 1.32; 95% CI: 1.09-1.60). Mortality increased significantly in the Midwest, South, and West, while the Northeast overall trend was not significant. Metropolitan AAMRs increased significantly through 2020. Most deaths occurred at home (18,212; 44.49%). Forecasts suggested overall AAMRs would remain near 0.82 per 100,000 in 2034, with widening prediction intervals.
Conclusions:
U.S. small bowel cancer-related mortality increased significantly, particularly after 2012, with variation by sex, age, geography, and urbanization.
