As a leading cause of morbidity and mortality in the United States, gastrointestinal (GI) cancers are diagnosed in 340,000 people and account for nearly 170,000 cancer-related deaths each year.1 Incidence and mortality rates of many GI cancers, including colon and rectum, stomach, and pancreas cancer, are also increasing among younger adults,2 and reasons for this increase remain poorly understood. In this issue of Gastroenterology, Ma et al3 examined county-level variation in GI cancer mortality rates using population-based data from the National Vital Statistics System at the Centers for Disease Control and Prevention; the authors also conducted a hotspot analysis to identify clusters of counties with higher mortality rates of colorectal cancer.