在美国各种族间的胃癌死亡率存在长期差距，然而这种模式在地理上的变化程度尚不为人所知。本分析估计了3110个美国县在20年内五个种族间的年龄标准化死亡率，以描述胃癌死亡率的空间 - 时间变异和种族间差异。我们应用了不足的死因代码重新分配方法和经验证的小区域估计方法，使用来自美国国家生命统计系统的死亡登记数据和来自美国国家卫生统计中心的人口数据，估计了胃癌年度死亡率。估计结果按县和种族间的分组进行了分层（非拉丁裔非西班牙裔美国土著或阿拉斯加土著[AIAN]，非拉丁裔亚洲人或太平洋岛民[亚洲]，非拉丁裔黑人[黑人]，拉丁裔或西班牙裔[拉丁裔]，非拉丁裔白人[白人]），从2000年到2019年。我们使用已发表的分类错误比例纠正了死亡证明上种族 - 种族组别的错误报告。对于具有少于1000人均年度人口的县和种族间的组合，我们遮盖（即不显示）了估计结果；因此，我们为3079个（3110个中的）县报告了总人口的估计结果，以及474个、667个、1488个、1478个和3051个分别属于AIAN、亚洲、黑人、拉丁裔和白人人口的县。在2000年至2019年之间，全国范围内每年的胃癌年龄标准化死亡率在白人人口中最低。全国范围内，这一时期各种族间的胃癌死亡率均有所下降，其中亚洲人口（下降百分比48.3% [45.1-51.1]）和黑人人口（下降百分比42.6% [40.2-44.6]）的下降速度最快。其他种族间的死亡率下降较为温和，其中白人、拉丁裔和AIAN人口的死亡率分别下降了36.7% (35.3-38.1)、35.1% (32.2-37.7)和31.6% (23.9-38.0)。在县一级也观察到类似的模式，尽管存在较大的地理变异。在2019年，多数县的少数族裔种族群体的死亡率较白人人口高：AIAN人口中81.1% (377个在两种族间均有解密估计值的465个县)、拉丁裔人口中88.2% (1295个在两种族间均有解密估计值的1469个县)、亚洲人口中99.4% (663个在两种族间均有解密估计值的667个县)、黑人人口中99.9% (1484个在两种族间均有解密估计值的1486个县)。然而，这些差距在各县之间范围广泛，AIAN人口的差距范围从0.3到17.1之间。在美国,胃癌死亡率在不同人群和地理区域上都有了显著下降。然而，在过去的20年里，不同族裔群体间的胃癌死亡率差距广泛存在并持续存在。地方层面的数据对于理解美国少数民族群体承受的不公平负担的范围至关重要。国家卫生与健康的少数民族研究所; 国家心脏,肺和血液研究所; 国家癌症研究所; 国家老年研究所; 国家关节炎和肌肉骨骼和皮肤疾病研究所; 疾病预防办公室; 以及国家健康研究所行为与社会科学研究办公室，美国国家卫生研究所（合同号75N94019C00016）。© 2023作者。

There are persistent disparities in stomach cancer mortality among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically is not well understood. This analysis estimated age-standardised mortality for five racial-ethnic groups, in 3110 USA counties over 20 years, to describe spatial-temporal variations in stomach cancer mortality and disparities between racial-ethnic groups.Redistribution methods for insufficient cause of death codes and validated small area estimation methods were applied to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual stomach cancer mortality rates. Estimates were stratified by county and racial-ethnic group (non-Latino and non-Hispanic [NL] American Indian or Alaska Native [AIAN], NL Asian or Pacific Islander [Asian], NL Black [Black], Latino or Hispanic [Latino], and NL White [White]) from 2000 to 2019. Estimates were corrected for misreporting of racial-ethnic group on death certificates using published misclassification ratios. We masked (ie, did not display) estimates for county and racial-ethnic group combinations with a mean annual population of less than 1000; thus, we report estimates for 3079 (of 3110) counties for the total population, and 474, 667, 1488, 1478, and 3051 counties for the AIAN, Asian, Black, Latino, and White populations, respectively.Between 2000 and 2019, national age-standardised stomach cancer mortality was lowest among the White population in every year. Nationally, stomach cancer mortality declined for all racial-ethnic groups across this time period, with the most rapid declines occurring among the Asian (percent decline 48.3% [45.1-51.1]) and Black populations (42.6% [40.2-44.6]). Mortality among the other racial-ethnic groups declined more moderately, decreasing by 36.7% (35.3-38.1), 35.1% (32.2-37.7), and 31.6% (23.9-38.0) among the White, Latino, and AIAN populations, respectively. Similar patterns were observed at the county level, although with wide geographic variation. In 2019, a majority of counties had higher mortality rates among minoritised racial-ethnic populations compared to the White population: 81.1% (377 of 465 counties with unmasked estimates for both racial-ethnic groups) among the AIAN population, 88.2% (1295 of 1469) among the Latino population, 99.4% (663 of 667) among the Asian population, and 99.9% (1484 of 1486) among the Black population. However, the size of these disparities ranged widely across counties, with the largest range from 0.3 to 17.1 among the AIAN population.Stomach cancer mortality has decreased substantially across populations and geographies in the USA. However, disparities in stomach cancer mortality among racial-ethnic groups are widespread and have persisted over the last two decades. Local-level data are crucial to understanding the scope of this unequal burden among minoritised groups in the USA.National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, National Institutes of Health (contract #75N94019C00016).© 2023 The Author(s).