Background: Kidney cancer (KC) is one of the leading causes of cancer mortality, with recent data showing an increase in incidence and mortality worldwide. Gender, racial, and ethnic disparities can impact KC outcomes. Studies investigating the outcomes of diverse patient populations spanning the cytokine, targeted therapy and immunotherapy eras have been limited. This study aims to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national and state levels. Methods: We utilized the Center for Disease Control Wonder database to extract national and state-wide KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender, race and ethnicity reported per 100,000 population. To evaluate the difference between metro and non-metro regions, we divided the national trends based on 2013 Urban NCHS Urban-Rural scheme. Joinpoint regression analysis was performed to evaluate trends. Results: In total, 284,224 KC deaths were reported over twenty years, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Amongst racial groups, American Indians (AI) had the highest mortality in 1999 (5.7). However, due to the smaller decrease of ASMR in Whites compared to Non-Whites, Whites showed the highest ASMR (3.9) in 2020. According to ethnicity, Non-Hispanics Whites (NHW) had significantly higher ASMR than Hispanics in 1999 (4.0 vs. 3.5) and 2020 (3.5 vs. 3.0) with a similar rate of decline (-11.4% vs. -12.5%). State-wise, ASMR decreased in all states except Utah (+45.8%), Arkansas (+18.4%), Hawaii (+15.4%), Montana (+5.3), Kansas (+2.7) and Nevada (+2.6). Interestingly, non-metro regions showed higher ASMR throughout the study period. Also, while there was a steep decline in ASMR (15%) in metro regions, only a minimal decline (-4.7%) was observed in non-metro regions. Conclusions: Over the last two decades, there has been a decrease in the ASMRs across all genders, races and ethnicities and in most states in the USA. The decrease in ASMR is likely multifactorial, related to earlier detection and improved treatments. However, differences in outcomes by gender, race, and ethnicity persist, highlighting the need for strategies to better understand the etiology of differences and mitigate disparities across social determinants of health across gender, racial, and ethnic groups.