ArticleBMC gastroenterology2026
Trends in mortality from liver cancer with hepatic fibrosis/cirrhosis in the United States, 1999-2020: a retrospective population-based study.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHepatic fibrosis and cirrhosis represent an important pathological continuum in the progression of chronic liver disease to primary liver cancer and are associated with poor prognosis. This study aimed to assess long-term mortality trends in liver cancer with hepatic fibrosis/cirrhosis coding in the United States from 1999 to 2020 and to examine disparities across demographic and geographic subgroups.
methodsDeath certificate data from 1999 to 2020 were obtained from the US Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) and 95% confidence intervals (CIs) were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC), identify inflection points, and compare temporal trends between groups.
resultsDuring the study period, 446,959 primary liver cancer deaths were recorded in the United States, of which 48,970 (10.96%) had hepatic fibrosis/cirrhosis-related codes documented on death certificates. The overall liver cancer AAMR was 5.928 per 100,000 population and showed a significant upward trend over the full study period (AAPC = 1.79%, P < 0.001), although a declining inflection point appeared after 2016. The AAMR for liver cancer with hepatic fibrosis/cirrhosis coding was 0.646 per 100,000 population and increased more rapidly (AAPC = 3.03%, P < 0.001). Subgroup analysis showed that the mortality rate was substantially higher in males (AAMR = 1.054) than in females (AAMR = 0.266), whereas the rate of increase was faster among females (AAPC = 4.09% vs. 2.62%). Hispanic or Latino individuals had the highest mortality rate (AAMR = 1.271). Nonmetropolitan areas experienced the most rapid increase in mortality (AAPC = 5.06%). Racial/ethnic analyses showed a significant increase among non-Hispanic White individuals (AAPC = 2.90%), whereas non-Hispanic Asian or Pacific Islander individuals exhibited a divergent pattern characterized by declining overall liver cancer mortality but stable mortality in the fibrosis/cirrhosis-coded subgroup.
conclusionsOver the past two decades, mortality from liver cancer with hepatic fibrosis/cirrhosis coding increased more rapidly than overall primary liver cancer mortality in the United States, indicating a growing epidemiologic burden in this coded subgroup. This pattern was particularly notable among males, Hispanic or Latino individuals, and nonmetropolitan residents. These findings support strengthening prevention and early management of progressive chronic liver disease while improving surveillance and care for populations at risk of advanced fibrosis/cirrhosis, with particular attention to health inequities.
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