Frontiers in oncology · 2026
Trends in liver failure-related mortality among middle-aged and older adults with digestive system malignant tumors in the United States, 1999-2023.
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Zhao Ling, Li Jiawei, Cheng Zhengjun, Ren Ao
Аннотация
BACKGROUND: Digestive system malignant tumors (DSMTs) represent a major contributor to global cancer-related morbidity and mortality. With improving cancer survival, coexisting conditions and complications, including liver failure, have become increasingly relevant in mortality patterns among patients with DSMTs. However, population-level evidence on temporal trends and disparities in liver failure-related mortality remains limited.
METHODS: This population-based retrospective repeated cross-sectional study used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Death records from 1999 to 2023 were analyzed among patients aged ≥45 years with DSMTs, defined by ICD-10 codes C15-C26. Liver failure was identified using ICD-10 code K72 under a multiple cause-of-death framework. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age group, race and ethnicity, urbanization level, Census region, and Health and Human Services (HHS) region.
RESULTS: From 1999 to 2023, a total of 82,796 liver failure-related deaths occurred among patients aged ≥45 years with DSMTs in the United States. Annual deaths declined from 4,131 in 1999 to 3,250 in 2023 (-21.33%). The AAMR decreased from 4.34 per 100,000 population (95% CI: 4.21-4.47) to 2.08 per 100,000 (95% CI: 2.01-2.15), corresponding to a significant overall decline (AAPC = -2.94%, 95% CI: -3.18 to -2.69). Although mortality declined across most subgroups, substantial heterogeneity persisted. Males consistently exhibited higher mortality than females, deaths were concentrated among older age groups, and liver failure-related deaths increased markedly among Hispanic individuals. Geographic analyses revealed pronounced regional variation, with attenuated declines or increasing trends in selected Census and HHS regions.
CONCLUSIONS: Liver failure-related mortality among middle-aged and older patients with DSMTs in the United States has declined substantially over the past two decades. However, this improvement has slowed in recent years and remains uneven across populations and regions. These findings support continued attention to liver function monitoring, liver disease risk assessment, and targeted surveillance in high-risk populations and regions.
METHODS: This population-based retrospective repeated cross-sectional study used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Death records from 1999 to 2023 were analyzed among patients aged ≥45 years with DSMTs, defined by ICD-10 codes C15-C26. Liver failure was identified using ICD-10 code K72 under a multiple cause-of-death framework. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age group, race and ethnicity, urbanization level, Census region, and Health and Human Services (HHS) region.
RESULTS: From 1999 to 2023, a total of 82,796 liver failure-related deaths occurred among patients aged ≥45 years with DSMTs in the United States. Annual deaths declined from 4,131 in 1999 to 3,250 in 2023 (-21.33%). The AAMR decreased from 4.34 per 100,000 population (95% CI: 4.21-4.47) to 2.08 per 100,000 (95% CI: 2.01-2.15), corresponding to a significant overall decline (AAPC = -2.94%, 95% CI: -3.18 to -2.69). Although mortality declined across most subgroups, substantial heterogeneity persisted. Males consistently exhibited higher mortality than females, deaths were concentrated among older age groups, and liver failure-related deaths increased markedly among Hispanic individuals. Geographic analyses revealed pronounced regional variation, with attenuated declines or increasing trends in selected Census and HHS regions.
CONCLUSIONS: Liver failure-related mortality among middle-aged and older patients with DSMTs in the United States has declined substantially over the past two decades. However, this improvement has slowed in recent years and remains uneven across populations and regions. These findings support continued attention to liver function monitoring, liver disease risk assessment, and targeted surveillance in high-risk populations and regions.