Department of Medicine, Beaumont Hospital, Royal Oak, MI 48073, USA.
Department of Medicine, University of Arizona Tucson, Tucson, AZ 85721, USA.
Viruses. 2024 Apr 28;16(5):694. doi: 10.3390/v16050694.
(1) Background: Hepatocellular carcinoma (HCC) contributes to the significant burden of cancer mortality in the United States (US). Despite highly efficacious antivirals, chronic viral hepatitis (CVH) remains an important cause of HCC. With advancements in therapeutic modalities, along with the aging of the population, we aimed to assess the contribution of CVH in HCC-related mortality in the US between 1999-2020. (2) Methods: We queried all deaths related to CVH and HCC in the multiple-causes-of-death files from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database between 1999-2020. Using the direct method of standardization, we adjusted all mortality information for age and compared the age-adjusted mortality rates (AAMRs) across demographic populations and by percentile rankings of social vulnerability. Temporal shifts in mortality were quantified using log-linear regression models. (3) Results: A total of 35,030 deaths were identified between 1999-2020. The overall crude mortality increased from 0.27 in 1999 to 8.32 in 2016, followed by a slight reduction to 7.04 in 2020. The cumulative AAMR during the study period was 4.43 (95% CI, 4.39-4.48). Males (AAMR 7.70) had higher mortality rates compared to females (AAMR 1.44). Mortality was higher among Hispanic populations (AAMR 6.72) compared to non-Hispanic populations (AAMR 4.18). Higher mortality was observed in US counties categorized as the most socially vulnerable (AAMR 5.20) compared to counties that are the least socially vulnerable (AAMR 2.53), with social vulnerability accounting for 2.67 excess deaths per 1,000,000 person-years. (4) Conclusions: Our epidemiological analysis revealed an overall increase in CVH-related HCC mortality between 1999-2008, followed by a stagnation period until 2020. CVH-related HCC mortality disproportionately affected males, Hispanic populations, and Black/African American populations, Western US regions, and socially vulnerable counties. These insights can help aid in the development of strategies to target vulnerable patients, focus on preventive efforts, and allocate resources to decrease HCC-related mortality.
(1) 背景：肝细胞癌（HCC）是导致美国癌症死亡率的主要原因之一。尽管有高效的抗病毒药物，慢性病毒性肝炎（CVH）仍然是 HCC 的一个重要病因。随着治疗方式的进步和人口老龄化，我们旨在评估 1999 年至 2020 年期间美国 CVH 在 HCC 相关死亡率中的作用。(2) 方法：我们在 1999 年至 2020 年期间，从疾病控制与预防中心广域在线流行病学研究（WONDER）数据库的多病因死亡文件中查询了所有与 CVH 和 HCC 相关的死亡。使用直接标准化法，我们调整了所有与年龄相关的死亡率信息，并比较了不同人口统计学人群和社会脆弱性百分位排名的年龄标准化死亡率（AAMR）。使用对数线性回归模型来量化死亡率的时间变化。(3) 结果：1999 年至 2020 年期间共确定了 35030 例死亡。总体粗死亡率从 1999 年的 0.27 上升到 2016 年的 8.32，随后略有下降到 2020 年的 7.04。研究期间的累积 AAMR 为 4.43（95%CI，4.39-4.48）。男性（AAMR 7.70）的死亡率高于女性（AAMR 1.44）。西班牙裔人群（AAMR 6.72）的死亡率高于非西班牙裔人群（AAMR 4.18）。社会脆弱性最高的美国县（AAMR 5.20）的死亡率高于社会脆弱性最低的县（AAMR 2.53），每 100 万人中有 2.67 人因社会脆弱性而额外死亡。(4) 结论：我们的流行病学分析显示，1999 年至 2008 年间，CVH 相关 HCC 死亡率总体呈上升趋势，随后至 2020 年期间停滞不前。CVH 相关 HCC 死亡率不成比例地影响男性、西班牙裔人群、黑人和非裔美国人人群、美国西部地区和社会脆弱性县。这些发现可以帮助制定策略，以针对弱势患者，关注预防工作，并分配资源来降低 HCC 相关死亡率。
