PO.SHP01.01 · 科学与健康政策
美国丙型肝炎病毒相关肝细胞癌死亡率的趋势与差异，1999-2023 年
Trends and disparities in hepatitis C virus-associated hepatocellular carcinoma mortality in the United States, 1999-2023
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
慢性丙型肝炎病毒（HCV）感染是美国肝细胞癌（HCC）的主要驱动因素，在过去 25 年中，美国 HCC 的发病率和死亡率翻了一番。尽管直接抗病毒药物有效，HCV 相关 HCC 仍然占相当比例，这强化了对持续监测和早期检测的需求。本研究遵循 STROBE 指南，使用 CDC-WONDER 数据分析了 1999 年至 2023 年间与 HCV 相关 HCC 相关的死亡。死亡通过 ICD-10 代码（B17.1、B18.2、C22.0）识别，并按死亡地点、年龄、性别、种族、人口普查区域和城市化程度进行人口学分类。计算了每 100,000 人口的年龄校正死亡率（AAMRs）。Joinpoint 回归评估趋势变化，报告平均年度变化百分比（AAPCs）及 95% CIs。使用 Joinpoint 软件、Microsoft Excel 和 CDC-WONDER 制图工具进行统计分析。从 1999 年至 2023 年，美国有 50,760 例死亡归因于 HCV 相关 HCC。AAMRs 从 1999 年的 0.19 上升至 2023 年的 0.43。在有死亡地点数据的死亡中，大多数发生在医疗机构（38.7%）或家中（35.0%）。Joinpoint 分析显示死亡率从 1999 年至 2012 年上升，至 2016 年保持稳定，随后至 2023 年下降（AAPC 2.52%）。女性 AAMRs 从 0.07 上升至 0.17，在 2013 年达到峰值后下降（AAPC 2.57%）。男性 AAMRs 从 0.31 上升至 0.73，早期激增，至 2016 年达到峰值，随后下降（AAPC 3.29%）。死亡率在 nH 白人中最高，其次是 nH 黑人。nH 白人上升至 2013 年，随后下降（AAPC 5.00%），而 nH 黑人早期急剧上升，并在 2016 年后下降（AAPC 4.30%）。大都市地区的 AAMRs 高于非大都市地区，两者均上升至 2010 年代中期，随后下降（AAPC 分别为 4.46% 和 6.03%）。各区域中，AAMRs 上升至 2010 年代中期，由东北部的早期急剧上升（32.1%）以及中西部、南部和西部的稳定增长（8-10%）驱动。死亡率在 55-64 岁和 65-74 岁人群中最高，两者均在 2013 年至 2017 年间急剧上升，随后下降（AAPC −3.94%）。HCV 相关 HCC 死亡率自 2010 年代初以来有所下降，但在性别、种族和地理之间仍不均衡。男性、黑人个体和城市地区承受最高负担。这些发现强调了在高风险人群中加强 HCV 检测、抗病毒治疗采用及及时 HCC 监测的必要性。
查看英文原文 English abstract
Chronic hepatitis C virus (HCV) infection is a major driver of hepatocellular carcinoma (HCC) in the United States, where HCC incidence and mortality have doubled over the past 25 years. Despite the effectiveness of direct-acting antivirals, HCV-related HCC remains substantial, reinforcing the need for sustained surveillance and early detection. This study, adhering to STROBE guidelines, analyzed deaths related to HCV-associated HCC from 1999 to 2023 using CDC-WONDER data. Deaths were identified via ICD-10 codes (B17.1, B18.2, C22.0), with demographic categorization by place of death, age, gender, race, census region, and urbanization. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression assessed trend changes, reporting Average Annual Percent Change (AAPCs) with 95% CIs. Statistical analyses were performed using Joinpoint software, Microsoft Excel, and CDC-WONDER mapping tools. From 1999 to 2023, 50,760 U.S. deaths were attributed to HCV-associated HCC. AAMRs increased from 0.19 in 1999 to 0.43 in 2023. Among deaths with place-of-death data, most occurred in medical facilities (38.7%) or at home (35.0%). Joinpoint analysis showed increasing mortality from 1999 to 2012, stable rates through 2016, and a decline to 2023 (AAPC 2.52%). Female AAMRs rose from 0.07 to 0.17, peaking in 2013 before declining (AAPC 2.57%). Male AAMRs increased from 0.31 to 0.73, with early surges, peaking through 2016, then declining (AAPC 3.29%). Mortality was highest in NH Whites, followed by NH Blacks. NH Whites rose until 2013, then declined (AAPC 5.00%), while NH Blacks showed early sharp increases and declined after 2016 (AAPC 4.30%). Metropolitan areas had higher AAMRs than non-metropolitan areas, with both rising until the mid-2010s followed by declines (AAPC: 4.46% and 6.03%, respectively). Across regions, AAMRs rose until the mid-2010s, driven by sharp early increases in the Northeast (32.1%) and steady growth in the Midwest, South, and West (8-10%). Mortality was highest in ages 55-64 and 65-74, both showing sharp increases from 2013 to 2017 followed by declines (AAPC −3.94%). HCV-related HCC mortality has declined since the early 2010s but remains uneven across sex, race, and geography. Males, Black individuals, and urban areas bear the highest burden. These findings underscore the need to strengthen HCV testing, antiviral treatment uptake, and timely HCC surveillance in the high-risk populations.
利益披露 Disclosure
S. Ahmed, None..
F. Baksh, None..
E. Krishnan, None..
A. Assad, None..
M. Uzair, None..
A. Nawaz, None..
O. Fatima, None..
S. Saleem, None.