Investigating demographic and geographic disparities in malnutrition and gastrointestinal cancer mortality among older adults in the United States: A comprehensive longitudinal Centers for Disease Control and Prevention WONDER analysis 1999–2020

Background: Malnutrition worsens gastrointestinal (GI) cancer outcomes in older adults; long-term US mortality trends and disparities remain insufficiently understood. This study analyzed demographic/geographic mortality trends related to malnutrition and GI cancer among older adults in the United States. Methods: Mortality data from 1999 to 2020 were obtained via CDC WONDER for adults aged ≥65 years, in which malnutrition and GI cancer were listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage changes (APCs) were calculated and stratified by year, sex, race/ethnicity, and region. Results: A total of 31,806 deaths were recorded. AAMRs declined from 4.4 in 1999 to 2.6 in 2013 (APC: −7.7 to −1.4), then rose to 5.5 in 2020 (APC: 11.6, 95% CI: 10.7–12.8). Men had higher AAMRs (4.3) than women (2.7). Among men, AAMRs dropped from 5.4 in 1999 to 3.3 in 2006, then increased to 7.2 in 2020 (APC: 11.9, 95% CI: 10.5–14.1). Women's rates declined from 3.8 in 1999 to 2.0 in 2013, before rising to 4.2 in 2020 (APC: 11.8, 95% CI: 10.2–14.0). Black or African American individuals (5.3), Alaska (7.1), and the Western United States (7.0) had the highest mortality. Nonmetropolitan areas consistently had higher AAMRs (4.0) than metropolitan areas (3.3). Conclusions: After years of decline, mortality from malnutrition and GI cancers has sharply increased among older adults, with notable sex, racial, and regional disparities. These findings underscore the need for focused public health strategies to address these growing inequalities.