Sex Differences in Gastric Cancer Mortality in Ecuador: A Joinpoint Regression Analysis

BACKGROUND: Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide. In Ecuador, GC was the primary cause of cancer-related deaths until 2013. Despite a general decline in GC mortality, significant regional and sex-based disparities persist. This study aimes to analyze trends in GC mortality by sex from 2004 to 2021 using Joinpoint regression analysis. METHODS: We analyzed GC mortality data from the National Institute of Statistics and Censuses (INEC) for the period 2004-2021. Age-standardized mortality rates (ASMR) were calculated using the SEGI world standard population. Joinpoint regression was applied to estimate the annual percentage change (APC) in mortality trends. Additionally, we examined regional differences and identified provinces with the highest mortality rates based on the average from 2017-2021. RESULTS: GC mortality rates declined nationally, with an annual decrease of 1.9% in men and 2.2% in women. However, significant regional disparities were observed. In the Coastal region, mortality rates among men showed no significant decline, while the rates for women decreased by 2.4% annually. In the Highlands, GC mortality declined by 1.8% in men and 2.4% in women, while in the Amazon region, the decrease was 2.8% and 3.0% per year for men and women, respectively. The highest GC mortality rates in 2021 were observed in Bolívar, Santo Domingo, and Cotopaxi among men, and in Zamora Chinchipe, Cotopaxi, and Loja among women. Notably, while most provinces experienced a decline, Esmeraldas reported an increasing mortality trend of 2.8% annually from 2004 to 2021. CONCLUSIONS: Despite an overall decline in GC mortality in Ecuador, disparities persist across regions and between sexes. The faster decline in female mortality suggests potential differences in risk factors, healthcare access, or early detection efforts.