Two decades of change: Tracking intrahepatic cholangiocarcinoma mortality in the United States from 1999 to 2020.

e16197 Background: Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy, recognized for its uncommon yet highly aggressive nature. In the United States, the incidence of ICC has been steadily rising, with a projected rise of up to 99% expected by 2029. Correspondingly, the overall mortality has been increasing in the United States over the past two decades for ICC. The 5-year survival rate remains very low at 9%, with cases rising globally. Objective: This 21-year retrospective analysis aims to study the multifaceted nature of ICC's growing incidence and mortality trends across the U.S. from 1999 to 2020 stratifying for demographic and regional variables. Through a comprehensive assessment of trends across various variables, our study provides a thorough understanding of high-risk demographics associated with ICC, aiming to address disparities and advocate for policy planning to ensure equitable access to cancer care across the globe. Methods: ICC mortality data was abstracted from CDC-WONDER from 1999-2020. Age-Adjusted Mortality Rate (AAMR) per 100,000 population and Annual Percentage Change (APC) along with 95% confidence intervals (CI) were determined. Joinpoint regression analysis was employed to examine trends across various demographic and regional groups. Results: A total of 113,450 ICC-related deaths occurred between 1999 and 2020. The overall-ICC related AAMR steadily increased from 0.98 in 1999 to 2.04 in 2020 with an APC of 3.55. Males had higher AAMR (2.32) as compared to females (1.83). Non-Hispanic (NH) Asian or Pacific Islander had the highest AAMR (2.61) in 2019, with the highest APC (4.19) recorded in NH-Black or African American individuals. Mortality rates were highest in people aged 85+, with the highest APC (4.43) observed in people aged 45-54. Wisconsin, Minnesota, Connecticut, Washington, Hawaii, and Rhode Island had approximately double AAMR compared to states that fell in the lower 10 th percentile. Large metropolitan had the highest AAMR (4.28) compared to rural areas. Conclusions: ICC mortality rates continue to rise alongside a low 5-year survival rate. Investigating contributing factors is essential, in conjunction with the outlined trends. Addressing demographic and regional disparities can enhance early diagnosis and treatment, improving public health outcomes. Annual percent change (APC) and age-adjusted mortality rates (AAMR) for intrahepatic cholangiocarcinoma (ICC) per 1000,000 population in the United States; 1999-2020. 1999 AAMR 2020 AAMR APC (95% CI) Overall 0.98 2.04 3.55 Males 1.13 2.32 3.35 Females 0.89 1.83 3.61 NH-Asian/Pacific 1.48 2.32 2.02 NH-Black 0.82 2.00 4.19 NH-White 0.98 2.01 3.54 Hispanic/Latino 1.20 2.05 2.93 Age 45-54 0.58 1.33 4.43 Large Metro 1.99 4.20 3.60