Geodemographic trends and disparities in liver cancer and sepsis-related mortality among adults aged ≥ 45 years in the United States, 1999-2024: A CDC WONDER analysis.

Abstract

e16163 Background: In the United States, Liver Cancer (LC) is emerging as one of six major cancers with increasing incidence rates. LC is linked to increased sepsis risk through weakened immune response, and chronic alcohol use further predisposes to progression of the disease and weak immune system. The combined burden of these conditions is poorly comprehended and is associated with increasing mortality. To overcome this gap, this study analyses national mortality trends in relation to geodemographic variables. Methods: To analyze mortality associated with LC (C22) and sepsis (A40-A41), we utilized the CDC WONDER database, to extract geo-demographic data among adults aged ≥45 years. Age-Adjusted Mortality rates (AAMRs) were standardized per 1 million. Joinpoint regression software evaluated Average Annual Percentage Change (AAPC) with 95% confidence intervals (CI). Results: LC and Sepsis accounted for 26,320 deaths over the study period, with AAMRs rising between 1999 and 2024 (AAPC: 5.1*; 95% CI: 4.9-5.3). Despite lower AAMRs, females exhibited a more pronounced increase in mortality relative to males (AAPC: 5.2*; 95% CI: 5.0-5.4). Older adults (65-85+ years) exhibited the most significant rise in mortality (AAPC: 5.3; 95% CI: 4.7-5.9), as compared to adults (44-65 years). Mortality rose among all racial groups, with the sharp increase observed in Non-Hispanic (NH) White populations (AAPC: 4.7*; 95% CI: 3.4-6.1). Similarly, among the census regions, most significant increase was observed in the Midwest (AAPC: 5.8*; 95% CI: 5.3-6.2). Urban-rural disparities were apparent, with steeper increases in nonmetropolitan regions. Conclusions: Our analysis revealed distinct patterns in LC and sepsis-related mortality. Increased risk among older adults, females, and NH White population, predominantly in rural areas in the Midwest census region, justifies the need for focused screening of premalignant liver diseases and enhanced treatment aligned with AASLD guidelines. These trends also establish the need for strict adherence to antibiotic stewardship, Fast blood culture and sensitivity tests for early infection control, and subsequent research aimed at optimizing disease management. Trends in liver cancer– and sepsis-related mortality in U.S. Variable AAMR 1999 AAMR 2024 AAPC (95% CI) Overall 4.2 12.9 5.1*(4.9-5.3) Gender:FemaleMale 2.96 8.917.7 5.2*(5.0-5.4)4.9*(4.6-5.2) Age:45-64 years65-85+ years 2.27.9 625 4.4*(4.0-4.8)5.3*(4.7-5.9) Race:HispanicNH AsianNH WhiteNH Black 11.410.53.95.7 19.919.111.918 3.5*(2.9-4.1)1.1*(0.5-1.7)4.7*(3.4-6.1)4.3*(3.8-4.8) Census region:NortheastMidwestSouthWest 4.33.14.35.5 10.610.613.815.4 3.7*(3.2-4.2)5.8*(5.3-6.2)5.5*(5.1-5.9)4.7*(4.4-5.1) Urbanization (1999-2020):MetroNonmetro 1999 4.62.9 2020 10.59.6 4.1*(2.8-5.4)6.4*(5.7-7.1) *Indicates p< 0.05