S178 Rising Mortality Trends Due To Cholangiocarcinoma and Primary Sclerosing Cholangitis in the United States: A 23-Year Retrospective Analysis (1999 to 2022)

Introduction: Cholangiocarcinoma (CCA), the leading malignancy in primary sclerosing cholangitis, 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 (CI) were analyzed. Results: Between 1999 and 2022, 211816 documented deaths were attributed to CCA in primary sclerosing cholangitis adults in the United States. The overall AAMR for CCA-related mortality increased in the United States from an adjusted rate 3.2 in 1999 to 5.3 in 2022 (APC: 2.24%; 95% CI: 2.17% to 2.34%). Men had consistently higher AAMRs than women (6 vs 4.7). The AAMR in United States men increased from 3.7 in 1999 to 6 in 2022 (APC: 2.07%; 95% CI: 1.93% to 2.27%). The AAMR in United States 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 (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. Conclusion: Mortality rates from cholangiocarcinoma in primary sclerosing cholangitis have risen overall in the U.S. over the past 2 decades. NH Asian or Pacific Islander, NH Black or African American, and Hispanic or Latino men remain at high risk, emphasizing the need for further investigation into effective prevention and treatment strategies.