Characteristics of early- versus late-onset esophageal adenocarcinoma: insights from the National Inpatient Sample 2016-2020.

Background: The incidence of early-onset esophageal adenocarcinoma (EAC) in adults aged <50 years is rising, yet remains under-investigated. This study compared demographic, clinical and socioeconomic predictors of early- vs. late-onset EAC using national hospitalization data.

Methods: We analyzed adult patients diagnosed with EAC from the National Inpatient Sample (2016-2020). Cases were stratified into early-onset (age <50 years) and late-onset (≥50 years), and further categorized by tumor location (upper, middle, lower esophagus). ICD-10-CM codes were used to identify diagnoses. Demographics, comorbidities and socioeconomic variables were compared using Rao-Scott chi-square tests.

Results: Among 105,228 EAC admissions, early-onset cases comprised 5.89%. Lower esophagus involvement was most common (74.6%). Compared to late-onset patients, early-onset cases had a lower proportion of Caucasians (71.5% vs. 79.8%, P<0.001) and higher proportions of Black (13.9% vs. 9.6%) and Hispanic individuals (7.0% vs. 5.4%). Smoking (25.1% vs. 17.9%), obesity (11.4% vs. 8.4%), and drug use (28.9% vs. 19.7%) were more prevalent in early-onset patients (P<0.001). In contrast, late-onset patients had higher rates of hypertension (47.1% vs. 26.7%), diabetes, chronic obstructive pulmonary disease and gastroesophageal reflex disease (P<0.001). Early-onset patients were less likely to be insured with Medicare (6.8% vs. 57.9%), and more likely with Medicaid (35.0% vs. 10.6%) or to be self-payers (3.9% vs. 1.8%).

Conclusions: Early-onset EAC presents with distinct racial, socioeconomic and clinical profiles compared to late-onset disease. These findings underscore the need for tailored screening strategies and further research to address disparities and risk factors in younger populations.