Temporal Trends and Disparities in Hepatitis-B Mortality in the United States Between 1999-2020: A Cross-sectional CDC WONDER Study

Abstract Aim To determine trends and disparities in hepatitis-B mortality in American adults older than 25 years between 1999-2020. Methods Retrospective analysis of CDC’s WONDER database was performed using ICD-10 codes for hepatitis-B. Age-adjusted mortality rates(AAMR) and crude death rates(CDR) per 100,000 persons were determined. Average annual percentage change(AAPC) was determined using Joinpoint regression. Results 38,845 deaths were reported. AAMRs declined sharply between 1999-2004(AAPC:-4.45) followed by a steady decline from 2004-2020(AAPC:-1.64), resulting in an overall AAPC of -2.31. Males had disproportionately higher mortality than females and showed a greater decline than females(AAPC:-2.62 vs -2.13). Among races, non-Hispanic(NH) Asian/Pacific Islanders had disproportionately higher AAMRs followed by NH Blacks, NH American Indians/Alaskan Natives, Hispanic, and NH Whites. All races saw declines in AAMR, with greatest decline seen in Hispanics(AAPC:-6.43). Geographically, AAMRs were highest in West followed by South. All census regions saw declines in AAMR, with greatest decline seen for Northeast(AAPC:-3.38). Metropolitan areas had higher AAMR than nonmetropolitan areas and saw greater decline in AAMR than nonmetropolitan areas(AAPC:-2.86 vs -0.55). Of the 10-year age groups, CDR was highest for 55-64 years(1.46). The age groups of 25-34, 35-44, 45-54, and 55-64 years saw declining AAMRs, with greatest decline seen for 35-44 years(AAPC:-5.64). However, 85+ years saw an increase in AAMRs(AAPC:1.12). Conclusion We found a significant decline in hepatitis-B mortality, though persistent disparities exist. Elderly males, NH Asian/Pacific Islanders, residents of West and metropolitan areas experienced disproportionately higher mortality rates.