Trends in esophageal cancer mortality in the United States (1999-2024): Disparities by sex, race/ethnicity, region, and urbanization.	BACKGROUND: Esophageal carcinoma is the seventh most common cancer worldwide and poses a significant public health concern due to its poor overall survival rates. Although treatment advances, including multimodal approaches and enhanced surgical techniques, have emerged, their effect on national mortality trends remains unclear. Understanding the temporal changes in esophageal cancer mortality and potential disparities across demographic and geographic subgroups is crucial for guiding targeted interventions and resource allocation. METHODS: We obtained mortality data for esophageal cancer from the CDC WONDER database covering the years 1999 to 2020, using the ICD-10 code (C15) for malignant neoplasm of the esophagus. Annual mortality rates were age-adjusted to the 2000 U.S. standard population and expressed per 10,000 and 100,000 persons. Analyses were stratified by sex (male, female), race/ethnicity (Non-Hispanic Black or African American, Non-Hispanic White, Hispanic), U.S. Census region (Northeast, Midwest, South, West), and urbanization status (rural versus urban). Joinpoint regression identified periods with distinct trends and estimated annual percent changes (APC); the average annual percent change (AAPC) summarized the overall trend. RESULTS: From 1999 to 2020, there were 374,000 recorded deaths from esophageal cancer across a population of over 8 billion. The overall AAMR declined from 4.36 (95 % CI: 4.28-4.44) in 1999 to 3.69 (3.63-3.75) in 2020 (AAPC:0.8 %). Sex disparities were observed, as males had significantly higher mortality (6.43 per 100,000) compared to females (1.38 per 100,000) in 2020, though both showed declining trends (AAPC:0.84 % and -1.12 %, respectively). By race/ethnicity, Black or African American individuals experienced the most pronounced decline, from 6.61 to 2.73 (AAPC:3.82 %), with particularly steep declines after 2018 (APC:1.58 %). Hispanic populations showed moderate decreases from 2.54 to 1.99 (AAPC:1.32 %), while White populations showed minimal change from 4.3 to 4.28 (AAPC:0.05 %). Regionally, the West experienced the greatest decline from 4.17 to 3.36 (AAPC:1.08 %), followed by the Northeast which fell from 4.61 to 3.57 (AAPC:1.07 %), the South from 4.23 to 3.56 (AAPC:0.89 %), and the Midwest displaying the smallest decrease from 4.46 to 4.37 (AAPC:0.31 %). Urban areas demonstrated a consistent decline (AAPC:1.09 %), while rural areas showed a modest increase from 4.16 to 4.52 (AAPC: 0.48 %). CONCLUSIONS: Mortality due to esophageal cancer in the U.S. has declined modestly from 1999 to 2020, showing substantial variation across demographic and geographic subgroups. Black or African American populations experienced a significant decline in mortality rates compared to other racial groups, while rural areas exhibited concerning increases in mortality rates. Persistent disparities by sex, race/ethnicity, and urbanization underscore the need for targeted prevention strategies, early detection initiatives, and enhanced access to specialized care, particularly in rural settings where mortality trends diverge from the national pattern.	esophagus