Andrew M Moon,Gabriel V Lupu,Ellen W Green,Sasha Deutsch-Link,Louise M Henderson,Hanna K Sanoff,Ted K Yanagihara,Nima Kokabi,David M Mauro,A Sidney Barritt
{"title":"肝细胞癌死亡的城乡差异是由丙型肝炎相关的HCC驱动的。","authors":"Andrew M Moon,Gabriel V Lupu,Ellen W Green,Sasha Deutsch-Link,Louise M Henderson,Hanna K Sanoff,Ted K Yanagihara,Nima Kokabi,David M Mauro,A Sidney Barritt","doi":"10.14309/ajg.0000000000003487","DOIUrl":null,"url":null,"abstract":"OBJECTIVES\r\nRecent data suggest emerging rural-urban disparities in hepatocellular carcinoma (HCC) burden in the US. We aimed to assess (1) trends in rural vs urban HCC-related mortality and (2) differences in underlying chronic liver disease etiologies contributing to HCC-related deaths.\r\n\r\nMETHODS\r\nWe utilized the National Vital Statistics System to examine crude and age-adjusted HCC death rates overall and by etiology for rural and urban residents from 2005-2023. Using the NCI Joinpoint Trend Analysis Software, we identified statistically significant changes in average percentage change (APC) in HCC mortality rates.\r\n\r\nRESULTS\r\nExamining mortality rates over time, average APC in HCC deaths were significantly higher in rural residents (crude AAPC 4.64, 95% CI 4.10, 5.34; age-adjusted AAPC 3.53, 95% CI 3.09, 4.07) compared to urban residents (crude AAPC 2.72, 95% CI 2.43, 3.01; age-adjusted AAPC 1.68, 95% CI 1.28, 2.13). Differences in HCC death rate changes were driven by a significantly greater recent decline in HCC cases from hepatitis C virus (HCV) in urban residents (crude APC -6.69, 95% CI -8.85, -5.30 from 2017-2023) compared to rural residents (crude APC -3.31, 95% CI -8.05, 0.73 from 2016-2023).\r\n\r\nCONCLUSIONS\r\nAnnual increases in HCC deaths have been more pronounced in rural compared to urban populations. Deaths from HCV-related HCC have declined with a geographical disparity that favors urban populations, possibly driven by decreased access to HCV screening or availability of highly effective direct-acting antiviral therapies for rural residents. These findings underscore the need for targeted HCV screening and treatment strategies in rural populations in addition to ongoing strategies to combat alcohol use and metabolic diseases.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"218 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Rural-urban disparities in hepatocellular carcinoma deaths are driven by hepatitis C-related HCC.\",\"authors\":\"Andrew M Moon,Gabriel V Lupu,Ellen W Green,Sasha Deutsch-Link,Louise M Henderson,Hanna K Sanoff,Ted K Yanagihara,Nima Kokabi,David M Mauro,A Sidney Barritt\",\"doi\":\"10.14309/ajg.0000000000003487\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVES\\r\\nRecent data suggest emerging rural-urban disparities in hepatocellular carcinoma (HCC) burden in the US. We aimed to assess (1) trends in rural vs urban HCC-related mortality and (2) differences in underlying chronic liver disease etiologies contributing to HCC-related deaths.\\r\\n\\r\\nMETHODS\\r\\nWe utilized the National Vital Statistics System to examine crude and age-adjusted HCC death rates overall and by etiology for rural and urban residents from 2005-2023. Using the NCI Joinpoint Trend Analysis Software, we identified statistically significant changes in average percentage change (APC) in HCC mortality rates.\\r\\n\\r\\nRESULTS\\r\\nExamining mortality rates over time, average APC in HCC deaths were significantly higher in rural residents (crude AAPC 4.64, 95% CI 4.10, 5.34; age-adjusted AAPC 3.53, 95% CI 3.09, 4.07) compared to urban residents (crude AAPC 2.72, 95% CI 2.43, 3.01; age-adjusted AAPC 1.68, 95% CI 1.28, 2.13). Differences in HCC death rate changes were driven by a significantly greater recent decline in HCC cases from hepatitis C virus (HCV) in urban residents (crude APC -6.69, 95% CI -8.85, -5.30 from 2017-2023) compared to rural residents (crude APC -3.31, 95% CI -8.05, 0.73 from 2016-2023).\\r\\n\\r\\nCONCLUSIONS\\r\\nAnnual increases in HCC deaths have been more pronounced in rural compared to urban populations. Deaths from HCV-related HCC have declined with a geographical disparity that favors urban populations, possibly driven by decreased access to HCV screening or availability of highly effective direct-acting antiviral therapies for rural residents. These findings underscore the need for targeted HCV screening and treatment strategies in rural populations in addition to ongoing strategies to combat alcohol use and metabolic diseases.\",\"PeriodicalId\":520099,\"journal\":{\"name\":\"The American Journal of Gastroenterology\",\"volume\":\"218 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The American Journal of Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14309/ajg.0000000000003487\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The American Journal of Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14309/ajg.0000000000003487","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的最近的数据表明,美国城乡之间的肝细胞癌(HCC)负担出现了差异。我们的目的是评估:(1)农村与城市 HCC 相关死亡率的趋势;(2)导致 HCC 相关死亡的慢性肝病病因的差异。方法我们利用全国人口动态统计系统(National Vital Statistics System)研究了 2005-2023 年期间农村和城市居民的 HCC 总死亡率和按病因调整的 HCC 总死亡率。使用 NCI 连接点趋势分析软件,我们确定了 HCC 死亡率平均百分比变化 (APC) 的显著统计学变化。64,95% CI 4.10,5.34;年龄调整后 AAPC 3.53,95% CI 3.09,4.07)明显高于城市居民(粗 AAPC 2.72,95% CI 2.43,3.01;年龄调整后 AAPC 1.68,95% CI 1.28,2.13)。与农村居民(粗APC -3.31,95% CI -8.05,0.73,从2016-2023年)相比,城市居民(粗APC -6.69,95% CI -8.85,-5.30,从2017-2023年)因丙型肝炎病毒(HCV)导致的HCC病例近期下降幅度明显更大,从而导致了HCC死亡率变化的差异。HCV相关HCC导致的死亡人数有所下降,但地域差异有利于城市人口,这可能是由于农村居民接受HCV筛查的机会减少或无法获得高效的直接作用抗病毒疗法。这些发现强调,除了正在实施的防治酗酒和代谢性疾病的策略外,还需要在农村人口中开展有针对性的 HCV 筛查和治疗策略。
Rural-urban disparities in hepatocellular carcinoma deaths are driven by hepatitis C-related HCC.
OBJECTIVES
Recent data suggest emerging rural-urban disparities in hepatocellular carcinoma (HCC) burden in the US. We aimed to assess (1) trends in rural vs urban HCC-related mortality and (2) differences in underlying chronic liver disease etiologies contributing to HCC-related deaths.
METHODS
We utilized the National Vital Statistics System to examine crude and age-adjusted HCC death rates overall and by etiology for rural and urban residents from 2005-2023. Using the NCI Joinpoint Trend Analysis Software, we identified statistically significant changes in average percentage change (APC) in HCC mortality rates.
RESULTS
Examining mortality rates over time, average APC in HCC deaths were significantly higher in rural residents (crude AAPC 4.64, 95% CI 4.10, 5.34; age-adjusted AAPC 3.53, 95% CI 3.09, 4.07) compared to urban residents (crude AAPC 2.72, 95% CI 2.43, 3.01; age-adjusted AAPC 1.68, 95% CI 1.28, 2.13). Differences in HCC death rate changes were driven by a significantly greater recent decline in HCC cases from hepatitis C virus (HCV) in urban residents (crude APC -6.69, 95% CI -8.85, -5.30 from 2017-2023) compared to rural residents (crude APC -3.31, 95% CI -8.05, 0.73 from 2016-2023).
CONCLUSIONS
Annual increases in HCC deaths have been more pronounced in rural compared to urban populations. Deaths from HCV-related HCC have declined with a geographical disparity that favors urban populations, possibly driven by decreased access to HCV screening or availability of highly effective direct-acting antiviral therapies for rural residents. These findings underscore the need for targeted HCV screening and treatment strategies in rural populations in addition to ongoing strategies to combat alcohol use and metabolic diseases.