e16255 Background: Cholangiocarcinoma (CCA) presents a rising global health concern. United States mortality patterns differ substantially between intrahepatic (iCCA) and extrahepatic (eCCA) subtypes. These divergent trends are essential to understand for anticipating future disease burden and tailored resource allocation. This study analyzes U.S. national mortality trends for iCCA and eCCA from 1999–2023, with projections through 2030. Methods: A population-based analysis using CDC WONDER multiple-cause-of-death data (1999–2023) was conducted. AAMRs; per 100,000, 2000 U.S. standard population and total deaths were extracted for iCCA and eCCA using ICD-10 codes C22.1 and C24.0. Temporal trends were assessed with Joinpoint Regression to estimate APC with 95% CI. p-value < 0.05 was considered significant. Projections to 2030 used the ARIMA model using R Software Version 4.5.0. Subgroup analyses included sex, ethnicity, U.S. Census regions, urbanization status, and state-level distributions. Results: From 1999–2023, iCCA accounted for 132,830 deaths, with a mean AAMR of 2.88, projected to rise to 6.08 by 2040 (95% CI: 4.64 – 7.52). In contrast, eCCA caused 18,699 deaths, with AAMR declining from 0.53 in 1999 to 0.43 in 2023 and projected to reach 0.38 by 2040 (95% CI: 0.27–0.47). iCCA mortality rose significantly in both sexes (APC: females 3.54%, males 3.20%, 1999–2023). eCCA declined in both sexes until 2012; thereafter, males demonstrated a statistically significant rise (APC 4.92%, 95% CI: 3.37–8.97; p = 0.038, 2012–2021). Hispanic (APC 2.82%) and non-Hispanic (APC 3.42%) individuals showed persistent increases in iCCA mortality. eCCA initially declined across both groups but rose sharply among Hispanics from 2013–2021 (APC 9.69%) before declining again. Across racial groups, the largest increases occurred among White individuals for iCCA (APC 4.03%, 95% CI: 3.11–5.26, 1999–2019) and among Black individuals for eCCA (APC 12.34%, 95% CI: 2.66–29.01, 2012–2017). Highest mean AAMRs for iCCA were observed in the Northeast (3.13), Large Central Metro areas (2.92), and Rhode Island (3.77). For eCCA, lowest AAMRs occurred in the Midwest (0.47), non-core counties (0.456), and Vermont (0.58). Using ARIMA model time series analysis based on historic trends iCCA mortality is projected to exhibit consistent increase from 4.19 in 2023 to 4.89 by 2030 (95% CI: 4.67- 5.11) while eCCA mortality is expected to decline slightly and stabilize to 0.39 in 2030 with 95% CI spanning from 0.27 to 0.51, compared to the more precise growth trajectory of iCCA. Conclusions: U.S. mortality from iCCA continues to surge across nearly all demographic groups, whereas eCCA shows a predominantly downward trend with recent resurgence. These sharply diverging patterns underscore the urgent need for subtype-specific prevention, surveillance, and tailored therapeutic strategies.
Ali et al. (Thu,) studied this question.