Temporal and regional mortality trends in patients with hypertension and hepatobiliary cancer in the United States from 1999 to 2020.

Abstract

e16310 Background: Hepatobiliary cancers (HBC) represent a diverse group of malignancies, contributing to approximately 13% of global cancer-related mortality. Among these, primary liver cancer remains the most prevalent, with over 41,000 new cases projected in 2024. Emerging evidence suggests that hypertension (HTN) is a potential risk factor for HBC, with underlying mechanisms hypothesized to involve dysregulation of the renin-angiotensin system (RAS). Additionally, arterial hypertension is increasingly recognized as a paraneoplastic manifestation of hepatocellular carcinoma. This association, however, remains inadequately explored in the existing literature. Notably, the RAS plays a critical role in modulating vascular tone, inflammation, and fibrogenesis, which may contribute to tumorigenesis in the hepatobiliary system, warranting further investigation.We aim to assess mortality trends due to HTN and HBC in the US from 1999 to 2020. Methods: We used the death certificate data from the CDC WONDER database to assess the crude death rates (CDRs) and age-adjusted mortality rates (AAMRs) per 100,000 individuals. Annual percent change (APC) and the average annual percent change (AAPC) evaluated the changes in AAMRs using Joinpoint regression. Results: Between 1999 and 2020, a total of 39,564 deaths were reported among patients with both HTN and HBC in the United States, exhibiting a significant upward trend (AAPC = 6.60). Mortality rates showed a steep rise from 1999 to 2001, followed by a more gradual increase until 2018, and then another marked rise till 2020. The highest CDRs were observed among individuals aged 85 years and older (5.79). AAMRs were higher in males (1.09) compared to females (0.7). Among racial and ethnic groups, Hispanics exhibited the highest AAMR (1.49), while non-Hispanic whites had the lowest (0.64). Regional differences in AAMRs were minimal but present, with the West reporting the highest (0.98) and the Northeast the lowest (0.66). The South and Midwest reported intermediate values (0.86 and 0.71, respectively). Texas (1.44) and California (1.33) had the highest AAMRs, whereas Utah (0.28) and Nevada (0.44) recorded the lowest. Rural (0.79) and urban (0.82) areas exhibited comparable AAMRs. The majority of deaths occurred in the decedent's home (17,590), followed by inpatient medical facilities (9,213). Conclusions: HTN and HBC related mortality among adults in the US demonstrated a rising trend from 1999 to 2020, with pronounced disparities observed among males, Hispanics, and residents of the Western region. These patterns highlight critical knowledge gaps and emphasize the necessity of future studies to study the association between these diseases and the complex interplay of biological, environmental, and systemic factors driving these inequities, thereby informing targeted prevention and management strategies.