Temporal Trends and Disparities in Liver Cell Carcinoma and Hepatic Failure Mortality in the United States: A 24-Year Analysis from CDC WONDER, 1999-2023

Abstract

Background: Liver cell carcinoma (LCC) and hepatic failure (HF) are significant contributors to liver-related mortality in the United States. This study assessed LCC- and HF-related mortality trends (1999–2023) using CDC WONDER data, stratified by demographics and geography. Methods: Deaths among U.S. adults aged ≥25 years with LCC (ICD-10: C22.0) or HF (ICD-10: K72.9) as underlying or contributing causes were analyzed. AAMRs per 1,000,000 were calculated by direct standardization to the 2000 U.S. standard population. Joinpoint regression estimated annual percent changes (APCs) in AAMRs, stratified by sex (1999–2023) and race/ethnicity, urban-rural status, census region, and state (1999–2020). Results: From 1999–2023, 22,963 adult deaths were recorded (77.6% men). Overall AAMR declined from 1999–2007 (APC: −2.4), was stable through 2017 (APC: +0.2), then fell through 2023 (APC: −3.5). Male AAMR followed a non-linear trajectory (APC: −2.1, 1999–2010; +0.7, 2010–2017; −4.4, 2017–2023); female AAMR was stable post-2006 (APC: −0.1). NH Asian or Pacific Islanders showed the steepest decline (APC: −6.7); Hispanics increased post-2010 (APC: +0.6). Metropolitan AAMR declined overall; non-metropolitan AAMR increased (APC: +1.3). The West had the highest regional AAMR (5.6 per 1,000,000); Hawaii the highest state-level AAMR (10.3 per 1,000,000). Conclusion:  LCC- and HF-related mortality declined overall, with descriptive subgroup variation by sex, race/ethnicity, urbanization, and geography. Targeted screening, hepatitis management, and equitable healthcare access are needed to address these patterns.