National burden of cholangiocarcinoma in the United States: A 20-year analysis of temporal trends and racial disparities (2005–2024).

Abstract

e16493 Background: Cholangiocarcinoma (CCA) is an uncommon but highly lethal malignancy with rising global concern, yet long-term U.S. epidemiologic data remain limited. Understanding contemporary trends in incidence, prevalence, demographic patterns, and racial or ethnic disparities is critical to guide prevention and early detection. We examined 20-year temporal patterns in CCA using a large real-world U.S. dataset. Methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network (2005–2024). Adults with ≥1 ICD-10-CM code for intrahepatic or extrahepatic CCA were included. Annual incidence and prevalence proportions, mean age at diagnosis, and demographic distributions were assessed. Temporal trends were analyzed using the Mann–Kendall test and Sen’s slope. Sex-stratified incidence trajectories were evaluated using Joinpoint regression (log-linear model; ≤3 Joinpoints). Race-stratified incidence rate ratios (IRRs) were estimated using Poisson regression with White patients as reference, adjusting for calendar year. Results: Among 111,355,335 individuals, 51,218 were diagnosed with CCA (0.046%). Incidence increased sixfold from 0.002% in 2005 to 0.012% in 2024 (τ = 0.923, p = 1.19×10⁻⁷), with a consistent annual rise of 4.70×10⁻⁶ (95% CI, 3.85×10⁻⁶–5.56×10⁻⁶). Prevalence increased more than fivefold (0.006% to 0.032%; τ = 0.992, p < 2.22×10⁻¹⁶). Mean age at diagnosis rose from 61.6 to 67.5 years, surpassing 65 years after 2015–2017, indicating progressive aging at presentation. Joinpoint analysis demonstrated distinct acceleration phases in 2007–2012 (APC 21.88%, p < 0.05) and 2021–2024 (APC 15.84%, p < 0.05), separated by a prolonged plateau. Sex-specific slopes were parallel despite persistently higher absolute incidence in males. Compared with White patients, incidence was significantly higher among Asian (IRR 1.205, 95% CI 1.156–1.257) and American Indian/Alaska Native patients (IRR 1.214, 95% CI 1.082–1.361), lower among Black patients (IRR 0.663, 95% CI 0.642–0.684), and comparable among Native Hawaiian/Other Pacific Islander patients. Incidence rose in both Hispanic and non-Hispanic populations, with consistently higher absolute rates among non-Hispanic patients. Conclusions: CCA incidence and prevalence increased substantially over 20 years in the United States, with aging at diagnosis and persistent racial disparities. These findings underscore a growing national burden and highlight the need for targeted prevention and early detection strategies.