P0934 - Disparities in Liver Cancer Mortality Rates Between Sex, Age, and Race-Specific Populations: Time-Trend Analysis of the CDC’s National Center of Health Statistics Database, 2000-2020

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Yazan Abboud, MD

Rutgers New Jersey Medical School
Newark, NJ

Yazan Abboud, MD¹, Mohamed Ismail, DO¹, Mohamad Khaled Almujarkesh, MD², John Esli Medina Morales, MD¹, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹
¹Rutgers New Jersey Medical School, Newark, NJ; ²Wayne State University School of Medicine, Detroit, MI

Introduction: Previous data showed increasing mortality rates of liver cancer in the US. However, there is limited data on sex and age-specific liver cancer mortality trends in race-specific groups. We conducted a comprehensive time-trend analysis of liver cancer mortality rates in demographic-specific populations using the CDC’s NCHS database.

Methods: Liver mortality data between 2000-2020 were obtained from the NCHS database, covering ~100% of US population. Age-adjusted mortality rates were calculated using SEER*Stat software and categorized by sex, age, & race into older adults(³55 years), younger adults(< 55 years), Non-Hispanic White(NHW), Non-Hispanic Black(NHB), Hispanic(H), Non-Hispanic American Indian/Alaska Native(NHAIAN), & Non-Hispanic Asian/Pacific Islander(NHAPI). Time trends [annual percentage change(APC) & average APC(AAPC)] were estimated using Joinpoint Regression and Monte Carlo permutation analysis. Sex-specific pairwise comparison was conducted to assess for parallelism & identicalness.

Results: There were 329,973 deaths attributed to liver cancer in the US between 2000-2020. In NHW(212,964 deaths), the rates were increasing in men and women without a difference(P=0.25). In older NHW, the rates were increasing in men at a greater rate compared to women(P=0.002). However, in younger NHW(23,270 deaths), the rates were decreasing in men but not women(AAPC difference=1.95; P=0.005). In NHB(48,376 deaths), the rates were increasing in men but not women(AAPC-difference=1.10; P=0.02), with similar results in older NHB. In younger NHB(8,440 deaths), the rates were decreasing in men at a greater rate compared to women(AAPC-difference=-3.22; P=0.07). In H(42,340 deaths), the rates were increasing in men but not women with similar results in older H. In younger H(6,695 deaths), the rates were decreasing in men and women without a difference(P=0.56). In NHAPI(22,263 deaths), the rates were decreasing in older and younger adults. In younger NHAIAN (477 deaths), the rates were decreasing in men but not women(AAPC-difference=-4.51; P=0.01).

Discussion: Nationwide data, covering ~100% of deaths attributed to liver cancer in the US, show that liver cancer mortality rates were increasing in most race groups. While mortality has been generally improving in younger adults, women experienced worse outcomes compared to men. This disparity was seen in NHW, NHB, and mostly in NHAIAN. Future studies are warranted to investigate risk factors associated with worse outcomes of liver cancer in younger women.

Figure: Figure: Sex-specific Trends and Age-Adjusted Mortality Rates Per 100,000 Population for Liver Cancer Among Different Age and Race Groups.

Age group, y	Deaths (N=329,973)^a	Trends^b			Sex-specific AAPC difference (95% CI)^c	Pairwise comparison P-values
		Time period	APC (95% CI)	AAPC (95% CI)		Sex-specific AAPC difference	Coincidence^d	Parallelism^e
Non-Hispanic White
All ages
Women	60,450 (18.32%)	2000-2010	0.55 (0.14 to 0.96)	0.88 (0.16 to 1.60)	0.55 (-040 to 1.51)	0.25	< 0.001	< 0.001
		2010-2014	3.46 (1.04 to 5.95)
		2014-2018	-1.25 (-3.46 to 1.01)
		2018-2020	1.70 (-2.66 to 6.27)
Men	152,514 (46.22%)	2000-2006	1.91 (1.10 to 2.73)	1.43 (0.81 to 2.05)
		2006-2012	3.16 (2.22 to 4.11)
		2012-2015	1.17 (-2.50 to 4.98)
		2015-2020	-1.02 (-1.80 to -0.23)
Aged ≥ 55
Women	55,722 (16.89%)	2000-2009	0.30 (-0.23 to 0.83)	0.94 (0.46 to 1.43)	1.00 (0.36 to 1.63)	0.002	< 0.001	< 0.001
		2009-2014	3.24 (1.55 to 4.96)
		2014-2020	0.02 (-0.78 to 0.83)
Men	133,560 (40.48%)	2000-2004	0.43 (-1.26 to 2.16)	1.94 (1.53 to 2.35)
		2004-2015	3.70 (3.34 to 4.05)
		2015-2020	-0.65 (-1.46 to 0.16)
Aged < 55
Women	4,569 (1.38%)	2000-2012	1.28 (0.16 to 2.42)	-0.82 (-1.84 to 0.21)	-1.95 (-3.30 to -0.59)	0.005	< 0.001	< 0.001
		2012-2020	-3.89 (-6.02 to 1.72)
Men	18,701 (5.67%)	2000-2004	7.26 (3.83 to 10.80)	-2.77 (-3.66 to -1.87)
		2004-2010	-0.40 (-2.41 to 1.66)
		2010-2020	-7.85 (-8.72 to -6.98)
Non-Hispanic Blacks
All ages
Women	13,014 (3.94%)	2000-2016	1.07 (1.07 to 0.52)	-0.11 (-0.95 to 0.73)	1.10 (0.18 to 2.02)	0.02	< 0.001	< 0.001
		2016-2020	-4.71 (-8.42 to -0.85)
Men	35,362 (10.72%)	2000-2013	2.86 (2.42 to 3.30)	0.99 (0.60 to 1.38)
		2013-2020	-2.40 (-3.25 to -1.54)
Aged Aged ≥ 55
Women	11,088 (3.36%)	2000-2016	1.65 (0.95 to 2.37)	0.43 (-0.60 to 1.47)	2.08 (0.95 to 3.21)	< 0.001	< 0.001	< 0.001
		2016-2020	-4.31 (-8.80 to 0.40)
Men	28,733 (8.71%)	2000-2013	4.79 (4.23 to 5.35)	2.51 (2.05 to 2.97)
		2013-2020	-1.59 (-2.54 to -0.64)
Aged < 55
Women	1,861 (0.56%)	2000-2010	-0.39 (-2.46 to 1.72)	-3.00 (-4.42 to -1.57)	-3.22 (-5.54 to -0.89)	0.07	< 0.001	< 0.001
		2010-2020	-5.55 (-7.78 to -3.26)
Men	6,579 (1.99%)	2000-2005	2.08 (-1.32 to 5.60)	-6.22 (-8.04 to -4.37)
		2005-2017	-7.15 (-8.21 to -6.07)
		2017-2020	-15.29 (-25.15 to -4.13)
Hispanics
All ages
Women	12,406 (3.76%)	2000-2015	0.85 (0.38 to 1.33)	0.26 (-0.29 to 0.81)	0.33 (-0.39 to 0.90)	0.36	< 0.001	0.006
		2015-2020	-1.50 (-3.34 to 0.38)
Men	29,934 (9.07%)	2000-2013	1.68 (1.12 to 2.24)	0.59 (0.12 to 1.06)
		2013-2020	-1.41 (-2.41 to -0.39)
Aged ≥55
Women	11,242 (3.41%)	2000-2018	0.87 (0.61 to 1.14)	0.30 (-0.31 to 0.90)	0.94 (0.14 to 1.74)	0.02	< 0.001	0.003
		2018-2020	-4.77 (-10.39 to 1.21)
Men	24,201 (7.33%)	2000-2013	2.23 (1.58 to 2.87)	1.24 (0.71 to 1.77)
		2013-2020	-0.58 (-1.67 to 0.53)
Aged < 55
Women	1,092 (0.33%)	2000-2020	-2.95 (-4.15 to-1.73)	-2.95 (-4.15 to -1.73)	-0.69 (-2.99 to 1.61)	0.55	< 0.001	0.35
Men	5,603 (1.70%)	2000-2004	5.41 (-2.44 to 13.88)	-3.64 (-5.62 to -1.62)
		2004-2016	-3.37 (-4.72 to -1.99)
		2016-2020	-12.65 (-18.76 to -6.07)
Non-Hispanic Asian Pacific Islander
All ages
Women	6,609 (2.00%)	2000-2020	-2.93 (-3.66 to -2.19)	-2.93 (-3.66 to -2.19)	0.66 (-0.16 to 1.48)	0.11	< 0.001	0.02
Men	15,654 (4.74%)	2000-2015	-1.36 (-1.72 to -1.00)	-2.27 (-2.72 to -1.83)
		2015-2020	-4.97 (-6.51 to -3.41)
Aged ≥ 55
Women	5,976 (1.81%)	2000-2020	-2.83 (-3.58 to -2.08)	-2.83 (-3.58 to -2.08)	1.14 (0.26 to 2.02)	0.011	< 0.001	0.001
Men	12,199 (3.70%)	2000-2015	-0.79 (-1.24 to -0.34)	-1.69 (-2.22 to -1.16)
		2015-2020	-4.34 (-6.15 to -2.50)
Aged < 55
Women	615 (0.19%)	2000-2020	-3.85 (-5.19 to -2.50)	-3.85 (-5.19 to -2.50)	-0.99 (-2.49 to 0.50)	0.19	< 0.001	0.61
Men	3,423 (1.04%)	2000-2013	-3.42 (-4.15 to -2.67)	-4.84 (-5.65 to -4.03)
		2013-2020	-7.44 (-9.45 to -5.38)
Non-Hispanic American Indian Alaska Native
All ages
Women	943 (0.29%)	2000-2020	1.15 (-0.08 to 2.39)	1.15 (-0.08 to 2.39)	1.06 (-0.28 to 2.41)	0.12	< 0.001	0.04
Men	2,101 (0.64%)	2000-2020	2.21 (1.48 to 2.95)	2.21 (1.48 to 2.95)
Aged ≥55
Women	846 (0.26%)	2000-2020	1.09 (-0.22 to 2.42)	1.09 (-0.22 to 2.42)	2.04 (0.50 to 3.57)	0.009	< 0.001	0.003
Men	1,709 (0.52%)	2000-2020	3.13 (2.17 to 4.09)	3.13 (2.17 to 4.09)
Aged < 55
Women	92 (0.03%)	2000-2020	1.79 (-1.56 to 5.25)	1.79 (-1.56 to 5.25)	-4.51 (-8.19 to -0.82)	0.01	< 0.001	0.01
Men	385 (0.12%)	2000-2020	-2.72 (-4.66 to -0.74)	-2.72 (-4.66 to -0.74

Table: Table: Sex-Specific Trends for Liver Cancer Mortality Among Different Age and Race Groups.
a Data are presented as death count numbers followed by percentages of the death count numbers from the total cases of deaths attributed to liver cancer in the database.
b Time-trends were computed using Joinpoint Regression Program (v4.9.0.1, NCI) with 3 maximum joinpoints allowed (4-line segments).
c A negative value indicates a greater AAPC in women compared to men.
d Tests whether sex-specific trends were identical. A significant P-value indicates that the trends were not identical (i.e., they had different mortality rates and coincidence was rejected).
e Tests whether sex-specific trends were parallel. A significant P-value indicates that the trends were not parallel (i.e., parallelism was rejected).

Disclosures:

Yazan Abboud indicated no relevant financial relationships.

Mohamed Ismail indicated no relevant financial relationships.

Mohamad Khaled Almujarkesh indicated no relevant financial relationships.

John Esli Medina Morales indicated no relevant financial relationships.

Nikolaos Pyrsopoulos: CytoSorbents – Grant/Research Support. Durect – Grant/Research Support. Gilead – Grant/Research Support. Grifols – Grant/Research Support. Mallinckrodt Pharmaceuticals – Consultant. Ocelot Bio – Grant/Research Support. Salix – Grant/Research Support.

Yazan Abboud, MD¹, Mohamed Ismail, DO¹, Mohamad Khaled Almujarkesh, MD², John Esli Medina Morales, MD¹, Nikolaos T.. Pyrsopoulos, MD, PhD, MBA¹. P0934 - Disparities in Liver Cancer Mortality Rates Between Sex, Age, and Race-Specific Populations: Time-Trend Analysis of the CDC’s National Center of Health Statistics Database, 2000-2020, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.