S457 Mortality Trends and Disparities Related to Colorectal Cancer With Liver Metastases Across the US Adult Population From 1999 to 2020: A CDC WONDER Analysis

Introduction: Colorectal cancer (CRC) with liver metastases affects approximately 50% of patients, significantly worsening survival. This study analyzes mortality trends from 1999 to 2020 to identify inequities and inform targeted interventions. Methods: Using CDC WONDER death certificate data (1999–2020) for adults aged 45 years and older with CRC (International Classification of Diseases, Tenth Revision code: C18–C21) and secondary liver metastases (C78.7), we calculated age-adjusted mortality rates (AAMRs) per 100,000 population, stratified by sex, race/ethnicity (e.g., Black, White), census region (Northeast, Midwest, South, West), urban-rural classification (e.g., micropolitan, large central metro), state, and place of death. Annual percent changes (APCs) were estimated via Joinpoint regression, with 95% confidence intervals (CIs); statistical significance was set at P < 0.05. Results: From 1999 to 2020, 101,618 deaths were attributed to CRC with liver metastases, with 48,470 occurring at the decedent’s home. AAMRs declined from 1999–2010, notably for men (1999–2008: APC -8.16 [-9.07, -7.24]), Black individuals (1999–2009: -7.99 [-9.55, -6.41]), the Northeast (1999–2010: -9.08 [-9.70, -8.46]), and medium metro areas (1999–2004: -9.17 [-11.76, -6.50]). Increases occurred post-2013, particularly for men (2013–2020: 5.39 [3.97, 6.83]), White individuals (2013–2016: 9.48 [1.03, 18.63]), the Midwest (2013–2020: 7.35 [5.52, 9.21]), and large fringe metro areas (2014–2017: 12.71 [4.42, 21.66]). In 2020, AAMRs were higher for men (5.46; 95% CI, 5.27–5.64) than women (3.38; 95% CI, 3.25–3.51); Black individuals (4.82; 95% CI, 4.47–5.17) than White (4.10; 95% CI, 3.95–4.25); the Midwest (4.80; 95% CI, 4.55–5.05) than the Northeast (2.60; 95% CI, 2.41–2.80); and micropolitan areas (5.80; 95% CI, 5.38–6.22) than large central metro areas (3.84; 95% CI, 3.65–4.04). Arkansas had the highest state AAMR (8.27; 95% CI, 7.91–8.62). Conclusion: CRC with liver metastases mortality declined until 2010 but increased through 2020, with persistent disparities by sex, race, region, and urbanization. Higher AAMRs among men, Black individuals, Midwest residents, and micropolitan populations highlight the need for enhanced screening and treatment access. Future research should investigate drivers of recent mortality increases to address these inequities effectively.