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This study systematically analyzes the incidence, mortality, age distribution, racial disparities, and geographic trends of ovarian cancer in the United States from 1999 to 2023 using Centers for Disease Control and Prevention surveillance data; evaluates changes in disease burden; and identifies health imbalances. This population-based ecological trend analysis used data from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research database. Age-adjusted mortality rates (AAMR, 1999/2018-2023) and age-adjusted incidence rates (1999/2017-2022) were extracted at national, state, racial (White, Black, American Indian/Alaska Native, Asian, and Hispanic), and regional (Northeast, Midwest, South, and West) levels. Joinpoint regression was used to calculate the annual percent change (APC) with 95% confidence intervals for trend analysis. Epidemiological characteristics were compared across the demographic and geographic strata. From 1999 to 2022/2023, a significant decreasing trend was observed in both age-adjusted incidence rate (14.1-9.9 per 100,000) and AAMR (8.8-5.5 per 100,000). The substantial gap between incidence rank (14th among all cancers) and mortality rank (seventh among all cancers) highlights the high lethality of ovarian cancer relative to its incidence, reflecting the poor prognosis associated with this malignancy. Markedly divergent trends have been observed across racial and regional groups. Racial analysis revealed statistically significant declines in AAMR for both White and Black populations. Geographically, the Midwest and South showed significant improvement (APC = -2.7% and -2.5%, respectively), while the West exhibited a nonsignificant decline (APC = -1.7%, P = .0904). The age distribution demonstrated a sharp increase in mortality burden after age 40, peaking in the 65 to 74 age group. Overall progress in ovarian cancer control has been achieved in the United States. However, the disease burden remained substantial and uneven. Significant racial and geographic disparities have led to profound health inequities. Future strategies should focus on monitoring disparities, precise prevention of high-risk groups, and ensuring equitable access to medical advancements.