Disparities in US public historic cancer mortality data: Advocacy for gastrointestinal cancers, tailored prevention measures, and the inclusion of oversea deaths. -Under-reporting of cancer deaths as sign of health disparity

Historically, data from US death certificates, available through the CDCs WONDER database, have been used to highlight health disparities. The 5 year (2018-2022) underlying-cause-of-death data were analyzed for different race/ethnicity groups. Gastrointestinal (GI) cancers of the colon/rectum, pancreas, liver/bile duct, and stomach contributed to more than a quarter of cancer deaths in the US, calling for focused advocacy. Known disparities for Black non-Hispanic Americans were verified in cancers of the colon/rectum, and pancreas. However, mortality data for "More than one race" non-Hispanic group or non-White Hispanic group appeared unreliable, suggesting that under-reporting is also a sign of health disparity. Age-specific death rates (ASDRs) were calculated to view health disparities in various age groups. Cancers of the colon/rectum, liver, and stomach cause significant mortality in the under-50 population. And minority groups are more likely to die from cancers in the liver or the stomach compared to the White non-Hispanics. Liver cancer crude death rate was lower than expect in Asian Non-Hipanics when compared with the high mortalities of IARCs GLOBOCAN estimates for Asian countries. Census data were then used to calculate Asian sub-groups ASDRs. Significantly higher risks were seen in gastric cancer for Korean Americans and liver cancer for Vietnamese Americans. The Asian Indian group had the lowest death rates across several GI cancers, even in gallbladder cancer. Some immigrants go back to their birth countries at end of life and these deaths are not reflected in WONDER because consulate reports of American citizens deaths abroad do not include race/ethnicity data. SIGNIFICANCEGastrointestinal cancers should be advocacy focuses to promote cancer equity. Under-reporting of deaths for minority groups is a sign of health disparity. ASDRs (Age Specific Death Rates) provide bases for tailored screening and prevention. Exclusion of American citizens deaths abroad in U.S. public health datasets may mask care access issues faced by immigrant cancer patients who may die overseas. Updating how these deaths are reported will help address this issue.