P2214 - Rising Mortality Trends due to Cholangiocarcinoma and Primary Sclerosing Cholangitis in the United States: A 23-Year Retrospective Analysis (1999-2022)

Sidra Naz, MD, MPH¹, Maitri Shah, MD², Adarsh Kumar. Jha, MD², Shreeya kumar. Adhikari, MD², Shazia Khan, MD³, Rishi Chowdhary, MD⁴, Dushyant S. Dahiya, MD⁵
1University of Texas MD Anderson Cancer Center, Houston, TX; 2University of Michigan Health - Sparrow, Lansing, MI; 3BronxCare Health System, New York, NY; 4Case Western Reserve University / MetroHealth, Cleveland, OH; 5University of Kansas School of Medicine, Kansas City, KS

Introduction: Cholangiocarcinoma (CCA), the leading malignancy in primary sclerosing cholangitis (PSC), has high mortality. This study examines mortality rates by demographic (sex, race/ethnicity, age) and geographic (state, urban-rural, region) subgroups.

Methods: Mortality trends for adults aged ≥ 25 years were analyzed using CDC WONDER database data, identifying deaths through ICD-10 codes C22.1 “Cholangiocarcinoma” and K83 “Primary sclerosing cholangitis”. Crude and age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) with 95% confidence intervals were analyzed.

Results: Between 1999 and 2022, 211816 documented deaths were attributed to CCA in PSC adults in the United States. The overall AAMR for CCA-related mortality increased in the US from an adjusted rate (AR) 3.2 in 1999 to 5.3 in 2022 (APC: 2.24%; 95% CI: 2.17% to 2.34%). Males had consistently higher AAMRs than females (6 vs. 4.7). The AAMR in US men increased from 3.7 in 1999 to 6 in 2022 (APC: 2.07%; 95% CI: 1.93% to 2.27%). The AAMR in US women increased from 2.8 in 1999 to 4.7 in 2022 (APC: 2.43%; 95%CI: 2.21% to 2.69%). The non-Hispanic (NH) Asian or Pacific Islander population had the greatest AAMR (5.9), followed by the NH Black or African American (AA) (5.5) and Hispanic or Latino population (5.3). Lower-risk groups were NH American Indian or Alaska Native (5) and NH White (4.9). AAMR also varied by region (South: 4.3; West: 4.6; Midwest: 4.9; Northeast: 5.2) and non-metropolitan areas had higher AAMR (small metro: 4.6; non-core areas: 4.9; micropolitan areas: 5) than metropolitan areas (large central metropolitan areas: 4.5; large fringe areas: 4.2). The states in the upper 90th percentile of AAMRs were Washington, Vermont, South Dakota, Wisconsin, Minnesota an approx. two-fold increase in AAMRs, compared to states falling in the lower 10th percentile Arizona, Georgia, Florida, Arkansas, Mississippi.

Discussion: Mortality rates from cholangiocarcinoma in primary sclerosing cholangitis have risen overall in the U.S. over the past two decades. NH Asian or Pacific Islander, NH Black or AA, and Hispanic or Latino men remain at high risk, emphasizing the need for further investigation into effective prevention and treatment strategies.


Figure: Annual Mortality Trends of Cholangiocarcinoma in adults with primary sclerosing cholangitis in the United States (1999–2022)

Disclosures:
Sidra Naz indicated no relevant financial relationships.
Maitri Shah indicated no relevant financial relationships.
Adarsh Jha indicated no relevant financial relationships.
Shreeya Adhikari indicated no relevant financial relationships.
Shazia Khan indicated no relevant financial relationships.
Rishi Chowdhary indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.

Sidra Naz, MD, MPH¹, Maitri Shah, MD², Adarsh Kumar. Jha, MD², Shreeya kumar. Adhikari, MD², Shazia Khan, MD³, Rishi Chowdhary, MD⁴, Dushyant S. Dahiya, MD⁵. P2214 - Rising Mortality Trends due to Cholangiocarcinoma and Primary Sclerosing Cholangitis in the United States: A 23-Year Retrospective Analysis (1999-2022), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.