Temporal Trends in Mortality Location Among Patients With Intrahepatic Cholangiocarcinoma in the USA: A Retrospective Observational Analysis of National Center for Health Statistics Mortality Data

Abstract

Objectives

Intrahepatic cholangiocarcinoma (ICC) is a malignancy with rising incidence and mortality in the United States. This study aimed to investigate temporal trends in the place of death among patients with ICC and assess demographic disparities.

Methods

We used the CDC WONDER database (2003–2020) for a retrospective study of patients who died from intrahepatic cholangiocarcinoma identified through death certificates. Place of death was categorized as hospice, home, inpatient, nursing home, or other. Age-adjusted mortality rates were calculated per 100 000. Temporal trends were assessed using the Mann-Kendall trend test, and associations between demographic characteristics and place of death were examined using the χ² test.

Results

Of 101 631 ICC-related deaths (AAMR: 1.61; 95% CI 1.60–1.62), the AAMR rose from 1.19 (95% CI 1.15–1.23) in 2003 to 2.04 (95% CI 2.00–2.08) in 2020. Over the study period, home was the most frequent place of death (44.6%), followed by inpatient facilities (28.4%), hospice (11.1%), and nursing homes (9.5%). Deaths at home and in hospice increased significantly (p < 0.01), while inpatient and nursing home deaths declined (p < 0.01). Disparities were observed across race, sex, age groups, and urbanization. Younger patients more often died in inpatient facilities, and minority racial groups were less likely to die at home or utilize hospice.

Conclusions

ICC-related deaths in the USA nearly doubled over the study period, with a marked shift from inpatient and nursing home deaths to hospice and home. Demographic disparities in end-of-life care underscore the need for targeted interventions to improve equitable access to palliative services.