Esophageal cancer related mortality among cancer admissions at Livingstone University Teaching Hospital southern province Zambia

Abstract

Esophageal cancer (EC) is a major cause of cancer-related mortality globally, with low- and middle-income countries (LMICs) disproportionately affected due to late-stage diagnoses and limited treatment access. In Sub-Saharan Africa, particularly the “esophageal cancer belt” that includes Zambia, incidence and mortality rates are among the highest worldwide. Within Zambia, the Southern and Eastern Provinces have seen rising EC cases. Despite frequent presentations at Livingstone University Teaching Hospital (LUTH), local data on EC-related mortality remains limited. This study aimed to determine the proportion of esophageal cancer (EC)–related deaths at Livingstone University Teaching Hospital (LUTH) and identify factors associated with mortality among patients diagnosed with cancer. A retrospective cross-sectional study was conducted using medical records of 212 adults admitted with any cancer diagnosis at Livingstone University Teaching Hospital (LUTH) between January 2023 and December 2024. The proportion of deaths attributable to esophageal cancer was assessed among all cancer patients. Sociodemographic and clinical data were collected through a standardized form. Descriptive analyses were performed, and multivariable logistic regression was employed to identify factors associated with mortality. Among the 212 individuals hospitalized with cancer, 53.1% were male (n = 112), with a median age of 63.5 years (IQR: 50–72 years). The proportion of EC-related deaths was 11.3% (n = 24) (95% CI 7.3%–16.3%), with males accounting for 75% of the deaths (n = 18). HIV-positive status (adjusted odds ratio [aOR] = 4.61; 95% CI 1.67–12.76; p = 0.003) and smoking (aOR = 6.79; 95% CI 2.30–20.07; p < 0.001) were significantly associated with mortality. EC continues to contribute significantly to cancer mortality at LUTH. HIV coinfection and smoking were strong predictors of death. Strengthening esophageal cancer surveillance among people living with HIV and promoting targeted tobacco cessation interventions, particularly among males, may support efforts to reduce mortality in high-burden settings.