Demographic, geographic, and facility-specific trends in malignant neoplasms of the bile duct mortality in the United States (1999–2020).

e22590 Background: Malignant neoplasms of the bile duct are rare but highly fatal cancers. Identifying mortality trends across race, gender, geography, and facility type is essential for addressing disparities, improving early detection, and guiding public health interventions. Methods: A retrospective analysis was conducted using CDC WONDER data from 1999 to 2020. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated and analyzed across states, genders, racial/ethnic groups, and care facilities. Descriptive statistics and trend analyses were used to assess disparities in bile duct cancer mortality. Results: A total of 107,149 deaths due to bile duct cancer were recorded from 1999 to 2020. Hawaii had the highest AAMR (1.9 per 100,000 population), while Mississippi had the lowest (0.8 per 100,000 population), highlighting significant geographic disparities. Gender analysis revealed a nearly equal burden among males (54,015 deaths) and females (53,134 deaths). Racial disparities were prominent, with Whites accounting for the highest number of deaths (90,674), followed by Black or African Americans (9,929), Hispanics (9,748), Asians or Pacific Islanders (5,806), and American Indian/Alaska Natives (740). Facility-specific mortality trends revealed that most deaths occurred in hospitals (500 deaths), followed by decedents’ homes (400 deaths) and emergency rooms (300 deaths). Conclusions: This study highlights significant disparities in bile duct cancer mortality across demographic and geographic factors. The nearly equal mortality burden among males and females suggests the need for further research into sex-based risk factors, disease progression, and treatment accessibility. Additionally, the disproportionate burden among Black, Hispanic, and Asian populations compared to American Indian/Alaska Natives underscores the need for further investigation into potential biological, socioeconomic, and healthcare access inequalities. Addressing these disparities requires targeted public health strategies, improved early detection efforts, and equitable access to hepatobiliary oncology services.