Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000-2016

July 17, 2018

Jiaquan Xu, M.D., NCHS Epidemiologist

Questions for Lead Author Jiaquan Xu, M.D., Epidemiologist, and Author of “Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000-2016

Q: What made you decide to focus on liver cancer deaths for this study?

JX: It was the dramatic rise in the death rate for liver cancer that caused me to want to look more deeply into various aspects of this marked change and produce this new report. I also wanted to offer state-by-state data for liver cancer mortality, so that the U.S. Public Health Community might have information that will help them in their important work throughout America. While we have seen decreases in death rates from many major causes — such as heart disease, cancer (all cancer combined), and stroke recently – liver cancer deaths stand out far away from the decreasing trends of these causes of death. To elaborate, the age-adjusted death rates for all cancer combined, have declined since 1990. Also, for the top six cancer death causes in 2016 (lung cancer, colorectal cancer, pancreatic cancer, breast cancer, prostate cancer, and liver cancer), the age-adjusted death rates decreased for four of them (lung, colorectal, breast, and prostate) and increased for two (liver cancer and pancreatic cancer) — with the liver cancer death rate increasing much faster than the pancreatic cancer death rate, since 2000.


Q: Was there a finding in your new report that you hadn’t expected and that really surprised you?

JX:  There actually are quite a few interesting results in this new analysis that surprised me. While there are some reports out there that show the increase of liver cancer mortality, we also know that the liver cancer death rate demonstrates a trend of continued rate increase during the period from 2000 through 2016 – which is the time span this report analyzed. The surprise is that the liver cancer death rate for men is between 2 and 2.5 times the rate for women aged 25 and over, during the period of 2000–2016. Within the four race/ethnic groups analyzed, the only decrease trend in liver cancer mortality observed, is for the non-Hispanic Asian or Pacific Islander (API) group. The rate increased for non-Hispanic white, non-Hispanic black, and Hispanic persons. Also the liver cancer death rates varied quite a bit by state, which is another surprising finding.


Q: What made you decide to focus on the age group of adults 25 years old and older?

JX: I had a number of reasons to focus on the liver cancer death rate for adults aged 25 and over. More than 99% of all deaths with liver cancer reported on the death certificate are for adults 25 years of age and over. It made sense to focus this analysis on the majority age group that dies from this cancer cause. We also know that age is a leading risk factor for the development of many types of cancer. Aging increases cancer risk. This is exactly what we see here in this new report. And the liver cancer death rate for older age groups is significantly higher than the rate for younger age groups throughout the period examined in this analysis.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

JX:  The differences among demographic groups is also what I found most surprising in this report. The liver cancer death rate for men aged 25 and over is between 2 and 2.5 times the rate for women. The liver cancer death rate varies by race/ethnic groups. The Non-Hispanic Asian or Pacific Islander (API) group have the highest liver cancer death rate among the four race/ethnic groups analyzed during 2000–2014. The rate for Hispanic adults surpassed the rate for non-Hispanic API and became the highest in 2016. The liver cancer death rate for non-Hispanic white adults was the lowest among the race/ethnic groups throughout the period (2000–2016).


Q: Why do you think there is such a vast difference among the states in death rates from liver cancer?

JX: The mortality data we analyzed does not provide any evidence itself to show the reason or reasons that could contribute to the variation of liver cancer death rates by state. In general, the majority of the liver cancer in the United States is often attributed to some potential risk factors such as metabolic disorders (including obesity, diabetes, and nonalcoholic fatty liver disease), chronic Hepatitis C (HCV) infection, excessive consumption of alcohol, smoking, and chronic Hepatitis B (HBV) infection. If the number of people affected by those potential risk factors is different from one state to another, the liver cancer incidence rate and death rate would vary.


Q: What do you think is the reason for the growing increase in deaths from liver cancer in the United States?

JX: The mortality data we analyzed does not provide any evidence itself to show the reason or reasons that could contribute to the rising of the liver cancer death rate in this country. Some risk factors might contribute to the increase in liver cancer incidence rate and death rate. For example, some attribute the baby boomer generation’s higher hepatitis C virus infection rate than other adult age groups. Some have identified an increase in the obesity rate as another reason. Unfortunately, we can’t answer this question with our data, though it is an important question.


Q: What would you say is the take-home message of this report?

JX: I think the real take-home message of this Data Brief is what it can offer to the Public Health Community to learn about liver cancer mortality variance among different groups. The report shows that liver cancer mortality varies by sex, age, race/ethnic groups, and by state. Although the overall liver cancer death rate increased from 2000 to 2016, the rate for non-Hispanic Asian or Pacific Islander (API) decreased. The rate for adults aged 45–54 has decreased since 2012.

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QuickStats: Percentage of Injury Deaths That Occurred in the Decedent’s Home for the Five Most Common Causes† of Injury Death — United States, 2016

July 9, 2018

In 2016, 31% of deaths from all causes of injury occurred in the person’s home.

The percentage varied by the cause of injury. More than half of the deaths attributable to poisoning (52%) occurred in the home.

Approximately 44% of deaths from firearms and suffocation occurred in the home.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality File. https://www.cdc.gov/nchs/nvss/deaths.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6726a6.htm


QuickStats: Homicide and Suicide† Death Rates for Persons Aged 15–19 Years — National Vital Statistics System, United States, 1999–201

June 8, 2018

In 1999, the homicide death rate for persons aged 15–19 years (10.4 per 100,000) was higher than the suicide rate (8.0). By 2010–2011, the homicide and suicide rates had converged.

After 2011, the suicide rate increased to 10.0 in 2016; the homicide rate declined through 2013 but then increased to 8.6 in 2016.

Source: National Vital Statistics System. 1999–2016. https://www.cdc.gov/nchs/nvss/deaths.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a7.htm


QuickStats: Breast Cancer Death Rates Among Women Aged 50–74 Years, by Race/Ethnicity — National Vital Statistics System, United States, 2006 and 2016

June 4, 2018

The U.S. death rate from breast cancer among all women aged 50–74 years decreased 15.1%, from 53.8 per 100,000 in 2006 to 45.7 in 2016.

In both 2006 and 2016, the death rate was higher among non-Hispanic black women compared with non-Hispanic white women and Hispanic women.

From 2006 to 2016, the death rate from breast cancer decreased for non-Hispanic white women from 54.6 per 100,000 to 46.2, for Hispanic women from 34.8 to 31.0, and for non-Hispanic black women from 71.7 to 64.1.

Source: National Vital Statistics System, 2006 and 2016. https://wonder.cdc.gov/ucd-icd10.html.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a8.htm


Recent Increases in Injury Mortality Among Children and Adolescents Aged 10–19 Years in the United States: 1999–2016

June 4, 2018

NCHS released a new report that presents numbers of injury deaths and death rates for children and adolescents aged 10–19 years in the United States for 1999–2016.

Numbers and rates are presented by sex for 1999–2016, by injury intent (e.g., unintentional, suicide, and homicide) and method (e.g., motor vehicle traffic, firearms, and suffocation). Numbers and rates of death according to leading injury intents and methods are shown by sex for ages 10–14 years and 15–19 years for 2016.

Findings:

  • The total death rate for persons aged 10–19 years declined 33% between 1999 (44.4 per 100,000 population) and 2013 (29.6) and then increased 12% between 2013 and 2016 (33.1).
  • This recent rise is attributable to an increase in injury deaths for persons aged 10–19 years during 2013–2016.
  • Increases occurred among all three leading injury intents (unintentional, suicide, and homicide) during 2013–2016.
  • Unintentional injury, the leading injury intent for children and adolescents aged 10–19 years in 2016, declined 49% between 1999 (20.6) and 2013 (10.6), and then increased 13% between 2013 and 2016 (12.0).
  • The death rate for suicide, the second leading injury intent among ages 10–19 years in 2016, declined 15% between 1999 and 2007 (from 4.6 to 3.9), and then increased 56% between 2007 and 2016 (6.1).
  • The death rate for homicide, the third leading intent of injury death in 2016, fluctuated and then declined 35% between 2007 (5.7) and 2014 (3.7) before increasing 27%, to 4.7 in 2016.

QuickStats: Age-Adjusted Death Rates for Drug Overdose by Race/Ethnicity — National Vital Statistics System, United States, 2015–2016

April 2, 2018

During 2015–2016, the age-adjusted death rates from drug overdose for the total population increased from 16.3 per 100,000 standard population to 19.8 (21.5%).

The rate increased from 21.1 to 25.3 (19.9%) for non-Hispanic whites, from 12.2 to 17.1 (40.2%) for non-Hispanic blacks, and from 7.7 to 9.5 (23.4%) for Hispanics.

Source: National Vital Statistics System, Underlying cause of death data, 1999–2016. https://wonder.cdc.gov/ucd-icd10.html.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a9.htm


Q and As on “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016”

December 21, 2017

Questions for Bob Anderson, Chief of the Mortality Statistics Branch, on the following reports, “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016.”

Q: How significant is it that life expectancy¹ in the U.S. has declined two years in a row?

A:  This is the first time life expectancy for the U.S. as a whole has declined two years in a row since 1962 and 1963, years in which there were severe flu outbreaks – and an increase in deaths from flu and pneumonia – in the U.S.


Q:  Since this is very rare, do we have any idea why this decline in life expectancy has happened again?

A:  We first have to look at the leading causes of death and see what is happening there.  For 7 out of the 10 leading causes of death in the U.S., mortality actually declined between 2015 and 2016.  But mortality from 3 causes of deaths increased.  Suicide rates increased 1.5% in 2016, and mortality from Alzheimer’s disease increased 3.1%.  However, mortality from accidents/unintentional injuries increased at a rate over three times that the increase of Alzheimer’s disease mortality – a 9.7% increase between 2015 and 2016.   And many of these accidental/unintentional deaths were from drug overdoses.


Q: How many deaths in 2016 were attributed to opioids?

A: In 2016, 42,249 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids.


Q: Why is the 63,632 number of overdose deaths smaller than what CDC has previously reported for 2016?

A: The 63,632 number is a final, official number of overdose deaths among U.S. residents for 2016 whereas the previously reported (and slightly higher) numbers were provisional estimates.

BACKGROUND:  In August of this year, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level.  These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc).  These counts also do not include deaths that are still under investigation.  As a result, the monthly numbers are provisional or very preliminary, and the final 2016 number of 63,632 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.


Q: In comparing the 2016 numbers with 2015 and past years, is the crisis of drug overdose deaths growing or about the same?

A: From 2015 to 2016, the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths, a 21% increase.  Over a longer period of time, from 1999 through 2016, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 18% per year from 2014 to 2016.  So this is a continuing, disturbing upward trend.


Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?

A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, doubled in one year, from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016. In 2016, 30% of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.


Q: Has fentanyl overtaken heroin as a major cause of overdose death?

A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, doubled between 2015 and 2016. In 2016, the rate of drug overdose deaths involving synthetic opioids other than methadone was 6.2 per 100,000 and the rate of drug overdose deaths involving heroin was 4.9 per 100,000.


Q: There is a lot of stark news in these two reports.  Are there any positives to report?

A: As mentioned, mortality from 7 out of the 10 leading causes of death in the U.S. declined in 2016; in fact, the overall mortality rate for the U.S. actually dropped despite the decline in life expectancy.  As for drug overdose deaths, the rate of increase in drug overdose deaths involving natural and semi-synthetic opioids, such as oxycodone and hydrocodone, is slowing. From 1999 to 2009, the rate increased on average by 13% per year but from 2009 to 2016, the rate increased by 3% per year.  And from 2006 to 2016, the rate of drug overdose deaths involving methadone decreased from 1.8 per 100,000 to 1.0 per 100,000.

The 2015 life expectancy estimate was revised to 78.7 years, down from 78.8 years, which was reported a year ago.

¹BACKGROUND: As a routine matter, for the highest degree of accuracy we blend Medicare data for people ages 66 and over with our vital statistics data to get a final, official estimate of life expectancy.  However, the two data sets are released on different schedules and occasionally, as with the 2015 estimates, the Medicare data for that year isn’t available at the time we release our final mortality statistics.