Increasing mortality burden among U.S. cancer patients with liver cirrhosis, 1999–2023

Liver cirrhosis and cancer are both major causes of morbidity and mortality worldwide. The presence of liver cirrhosis may complicate cancer management and adversely affect clinical outcomes. However, the long-term mortality burden among individuals with both cancer and liver cirrhosis remains poorly characterized in the United States. This study collected data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database on deaths among adults aged ≥ 25 years in the United States from 1999 to 2023 with co-mention of cancer and cirrhosis. Joinpoint regression analysis was used to examine mortality trends overall and by gender, age, race, census region, urbanization, and state. Sensitivity and subgroup analyses were performed to assess the robustness of the findings. An autoregressive integrated moving average (ARIMA) model was used to project mortality trends from 2024 to 2033. A total of 149,340 deaths were identified during the study period. The age-adjusted mortality rate (AAMR) increased from 2.08 per 100,000 population in 1999 to 3.51 per 100,000 population in 2023 (AAPC = 2.13%, 95% CI: 1.78%–2.49%). Mortality trends varied across demographic and geographic subgroups, with the fastest increases among females, Non-Hispanic (NH) White individuals, adults aged ≥ 85 years, residents of the South, and nonmetropolitan areas. In site-stratified analyses, mortality increased in both subgroups. For liver cancer, the AAMR increased from 0.80 to 1.65 per 100,000 population (AAPC = 2.82%, 95% CI: 2.28%–3.37%), whereas for extrahepatic cancers it increased from 1.28 to 2.09 per 100,000 population (AAPC = 2.18%, 95% CI: 1.76%–2.61%). The extrahepatic cancer subgroup had a higher AAMR in 2023, although the liver cancer subgroup showed a slightly faster long-term increase. Sensitivity analyses were consistent with the primary findings. From 1999 to 2023, mortality among cancer patients with cirrhosis in the United States showed an upward trend and is projected to continue rising over the next decade. The AAMR for extrahepatic cancers was higher than that for liver cancer in 2023, although the liver cancer subgroup had a slightly higher AAPC.