Examining the link between tobacco use and gastric cancer mortality: A US population-based perspective (2003 to 2023)

Abstract

Gastric cancer (GC) remains a major cause of cancer-related mortality worldwide, driven by multiple risk factors including infection, diet, genetics, and lifestyle behaviors. Tobacco use is a well-established modifiable risk factor that contributes to gastric carcinogenesis through chronic mucosal injury. This study aimed to evaluate long-term mortality trends of tobacco-associated GC among United States adults aged ≥ 25 years. We conducted a retrospective cross-sectional analysis using the CDC WONDER Multiple Cause of Death database from 2003 to 2023. Adults aged ≥ 25 years with GC (International Classification of Diseases, Tenth Revision: C16) and tobacco use disorder (International Classification of Diseases, Tenth Revision: F17) listed as underlying or contributing causes of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression, reporting annual percent change and average annual percent change (AAPC). A total of 17,357 deaths were attributed to tobacco-associated GC (overall AAMR: 0.34). Mortality was higher among males (AAMR: 0.58) compared with females (AAMR: 0.15), with comparable temporal trends (AAPC: 4.59% vs 4.58%, respectively). Overall AAMR increased significantly from 0.15 in 2003 to 0.40 in 2023 (AAPC: 4.60%; 95% confidence interval: 3.11-6.18). Across racial groups, non-Hispanic (NH) Black individuals exhibited the highest mortality burden (AAMR: 0.56). However, NH White individuals demonstrated the steepest relative increase over time (AAPC: 3.89%). Regionally, the Midwest had the highest mortality burden (AAMR: 0.45) and the fastest growth (AAPC: 7.33%). Nonmetropolitan areas showed higher mortality (AAMR: 0.45) and a greater increase (AAPC: 4.73%) than metropolitan areas (AAMR: 0.33; AAPC: 4.14%). Tobacco-associated GC mortality has increased significantly in the United States from 2003 to 2023. While NH Black individuals bear the greatest overall mortality burden, NH White individuals exhibit the steepest rise in mortality rates. Higher burden and growth in the Midwest and rural areas highlight persistent geographic disparities.