Temporal trends and demographic disparities in cardiovascular disease (CVD) and hepatocellular carcinoma (HCC)–related mortality in the United States, 1999–2020: CDC WONDER Analysis.

Abstract

e16360 Background: Hepatocellular Carcinoma (HCC) is the fifth most common cause of cancer worldwide. Five-year survival of HCC is 18% and second to pancreatic cancer. Cardiovascular disease (CVD) is increasingly recognized as a major competing cause of death in patients with liver disease, but national data on long-term trends and demographic disparities in CVD-associated mortality among the HCC population are limited. This study aims to analyze demographic disparities and temporal trends among adults aged 25 and older from 1999 to 2020. Methods: Data from CDC WONDER was extracted using ICD-10 codes C22 (Malignant neoplasm of liver and intrahepatic bile ducts) and I00-I99 (Diseases of the circulatory system) from 1999 to 2020 to obtain age-adjusted mortality rates (AAMR) per million stratified by year, gender, race, state, urban-rural status, census region, and place of death (POD). Joint Point regression analysis was performed to calculate annual percent change (APC) and average annual percent change (AAPC). Results: About 98,777 deaths were reported during the study period. Overall, AAMR increased from 15.461 in 1999 to 25.79 in 2020, 2.36% per year (AAPC 2.36%; 95% CI 2.22–2.50; P < 0.000001). AAMR for males (30.38 vs 12.22) was higher than for females, with a trend increase of rate in males (AAPC: 2.46% per year (95% CI, 2.28–2.63)) compared to females (AAPC: 1.86% per year (95% CI, 1.57–2.14)). Non-Hispanic (NH) Asian or Pacific Islander had the highest AAMR (40.4), followed closely by Hispanic White (39.2), NH American Indian or Alaska Native (29.1), NH Black or African American (27.83), Hispanic Asian or Pacific Islander (20.2), and lastly NH White (16.6). Among the regions, the West had the highest AAMR (27.9), followed by the Northeast (22.264), the South (18.534), and lastly the Midwest (16.051). Urban areas had higher AAMR (20.872) than rural areas (18.03). California had the highest AAMR of 39.5. The majority of deaths occurred at the decedents' homes (39.5%), followed by inpatient medical facilities (32.7%). Conclusions: Mortality rates have been increasing steadily from 1999 to 2020 in HCC patients with CVD, with marked disparities among sex, race, region, urban-rural, state, and place of death, with the highest burdens among NH Asian/Pacific Islander and Hispanic populations, residents of the West, and urban areas. These findings underscore the need for targeted research and prevention strategies in high-risk demographic groups to mitigate the growing burden.