What is the clinical evidence from this study?

Study design: Observational. Population: Hepatocellular Carcinoma and Cardiovascular disease (n=98777). Primary outcome: Age-adjusted mortality rates (AAMR) per million (AAPC 2.36%, 95% CI 2.22-2.50, p=<0.000001).

What does this research mean for the field?

Cardiovascular disease-associated mortality among patients with hepatocellular carcinoma in the United States increased steadily from 1999 to 2020, with significant disparities disproportionately affecting males, Non-Hispanic Asian/Pacific Islanders, and urban residents in the West. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 30, 2026

Temporal trends and demographic disparities in cardiovascular disease (CVD) and hepatocellular carcinoma (HCC)–related mortality in the United States, 1999–2020: CDC WONDER Analysis.

Q: What are the key findings of this study?

Age-adjusted mortality rates for HCC patients with cardiovascular disease increased from 15.461 per million in 1999 to 25.79 in 2020 (AAPC 2.36%; 95% CI 2.22-2.50; P<0.000001).

Q: What does this research mean for the field?

Cardiovascular disease-associated mortality among patients with hepatocellular carcinoma in the United States increased steadily from 1999 to 2020, with significant disparities disproportionately affecting males, Non-Hispanic Asian/Pacific Islanders, and urban residents in the West. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This study analyzes the trends and disparities in cardiovascular disease (CVD) and hepatocellular carcinoma (HCC) mortality from 1999 to 2020 in the U.S.

Key Result

Age-adjusted mortality rates for HCC patients with cardiovascular disease increased from 15.461 per million in 1999 to 25.79 in 2020 (AAPC 2.36%; 95% CI 2.22-2.50; P<0.000001).

Key Points

This study analyzes the trends and disparities in cardiovascular disease (CVD) and hepatocellular carcinoma (HCC) mortality from 1999 to 2020 in the U.S.
Data extracted from CDC WONDER using ICD-10 codes for liver cancer and circulatory diseases from 1999 to 2020.
Age-adjusted mortality rates were stratified by year, gender, race, and region, among others.
Joint Point regression analysis calculated annual percent change (APC) and average annual percent change (AAPC).
AAMR increased from 15.461 in 1999 to 25.79 in 2020, with an AAPC of 2.36% (95% CI 2.22–2.50, P < 0.000001).
Higher AAMR in males (30.38) compared to females (12.22), with males showing a trend increase of 2.46% per year (95% CI, 2.28–2.63).
NH Asian or Pacific Islander had the highest AAMR at 40.4, with urban areas also showing higher mortality rates (20.872) compared to rural areas (18.03).

Study Design

Type

Observational (n=98,777)

Multicenter

Yes

Structured PICO

Population

98,777 adults aged 25 and older with Hepatocellular Carcinoma (HCC) and Cardiovascular disease (CVD) in the United States from 1999 to 2020.

Outcome

Age-adjusted mortality rates (AAMR) per million for HCC and CVD-related mortalityhard clinical

CVD-associated mortality in patients with HCC has steadily increased in the US from 1999 to 2020, highlighting the need for targeted prevention strategies in high-risk demographic groups.

Main Result

Effect estimate: AAPC 2.36% (95% CI 2.22-2.50)

Absolute Event Rate: 25.79% vs 15.461%

p-value: p=<0.000001

Abstract

e16360 Background: Hepatocellular Carcinoma (HCC) is the fifth most common cause of cancer worldwide. Five-year survival of HCC is 18% and second to pancreatic cancer. Cardiovascular disease (CVD) is increasingly recognized as a major competing cause of death in patients with liver disease, but national data on long-term trends and demographic disparities in CVD-associated mortality among the HCC population are limited. This study aims to analyze demographic disparities and temporal trends among adults aged 25 and older from 1999 to 2020. Methods: Data from CDC WONDER was extracted using ICD-10 codes C22 (Malignant neoplasm of liver and intrahepatic bile ducts) and I00-I99 (Diseases of the circulatory system) from 1999 to 2020 to obtain age-adjusted mortality rates (AAMR) per million stratified by year, gender, race, state, urban-rural status, census region, and place of death (POD). Joint Point regression analysis was performed to calculate annual percent change (APC) and average annual percent change (AAPC). Results: About 98,777 deaths were reported during the study period. Overall, AAMR increased from 15.461 in 1999 to 25.79 in 2020, 2.36% per year (AAPC 2.36%; 95% CI 2.22–2.50; P < 0.000001). AAMR for males (30.38 vs 12.22) was higher than for females, with a trend increase of rate in males (AAPC: 2.46% per year (95% CI, 2.28–2.63)) compared to females (AAPC: 1.86% per year (95% CI, 1.57–2.14)). Non-Hispanic (NH) Asian or Pacific Islander had the highest AAMR (40.4), followed closely by Hispanic White (39.2), NH American Indian or Alaska Native (29.1), NH Black or African American (27.83), Hispanic Asian or Pacific Islander (20.2), and lastly NH White (16.6). Among the regions, the West had the highest AAMR (27.9), followed by the Northeast (22.264), the South (18.534), and lastly the Midwest (16.051). Urban areas had higher AAMR (20.872) than rural areas (18.03). California had the highest AAMR of 39.5. The majority of deaths occurred at the decedents' homes (39.5%), followed by inpatient medical facilities (32.7%). Conclusions: Mortality rates have been increasing steadily from 1999 to 2020 in HCC patients with CVD, with marked disparities among sex, race, region, urban-rural, state, and place of death, with the highest burdens among NH Asian/Pacific Islander and Hispanic populations, residents of the West, and urban areas. These findings underscore the need for targeted research and prevention strategies in high-risk demographic groups to mitigate the growing burden.

Mark Helpful

Bookmark

Relay