Heart failure–related mortality among U.S. liver and intrahepatic bile duct cancer patients: A 25-year CDC WONDER analysis.

Abstract

e16220 Background: Liver and intrahepatic bile duct cancer (L/IBDC) is a leading cause of cancer mortality worldwide. Comorbid heart failure (HF) may exacerbate outcomes, yet national trends in HF-related mortality among L/IBDC patients remain poorly characterized. This study evaluates U.S. mortality trends from 1999–2023. Methods: This study, adhering to STROBE guidelines, analyzed heart failure–related mortality trends among U.S. adults (≥25 years) with liver and intrahepatic bile duct cancer from 1999–2023 using CDC WONDER Multiple Cause of Death (MCOD) data. Deaths were identified via ICD-10 codes for L/IBDC (C22.0–C22.4, C22.7, C22.9) and HF (I50.0–I50.1, I50.9), with demographic categorization by age, sex, race/ethnicity, census region, state, place of death, and urbanization. Crude and age-adjusted mortality rates (CRs and AAMRs) were calculated per 100,000 population. Joinpoint regression assessed trend changes, reporting Annual Percent Changes (APCs) and Average Annual Percent Change (AAPCs) with 95% CIs. Results: From 1999–2023, 15,669 deaths occurred among adults with L/IBDC and HF (AAMR: 0.21–0.50). Overall, AAMRs increased, with APCs of 0.57 (1999–2012) and 7.53 (2012–2023). Males had higher AAMRs than females throughout the study period, with the largest rise from 2014–2023 (0.35–0.71; APC 7.58). Older adults (65–85+) had the highest mortality, with AAMRs increasing from 0.92–2.18 (APC 8.90, 2014–2023). Regionally, the Southern U.S. experienced the highest mortality (0.51; 95% CI: 0.47–0.56; APC 8.71), while the lowest increases were observed in the West (0.24–0.78). Metropolitan areas had consistently higher AAMRs than non-metropolitan areas (0.18–0.36; APC 6.32, 2012–2020). Non-Hispanic Whites had higher mortality than non-Hispanic Blacks (0.18–0.51; APC 8.56, 2012–2023). Most deaths occurred at home (1999–2020: n = 4,512; 2021–2023: n = 1,580). State-level AAMRs were highest in Mississippi (0.39; 95% CI: 0.33–0.45, 1999–2020) and Minnesota (0.78; 95% CI: 0.63–0.93, 2021–2023), and lowest in Arizona (0.13; 95% CI: 0.11–0.15) and New York (0.24; 95% CI: 0.20–0.28). Conclusions: HF-related mortality among L/IBDC patients has risen steadily over the past two decades, particularly among males, older adults, non-Hispanic Whites, and residents of Southern metropolitan regions. Recognition of these trends can guide targeted interventions, improve management of HF in L/IBDC patients, and inform public health strategies.