title: Increasing mortality in the United States from cholangiocarcinoma: an analysis of the National Center for Health Statistics Database.
abstract: BACKGROUND
  While mortality in the United States has decreased for most cancers, mortality from combined hepatocellular liver cancer and intrahepatic cholangiocarcinoma (ICC) has increased and ranked 1st in annual percent increase among cancer sites. Because reported statistics combine ICC with other liver cancers, mortality rates of cholangiocarcinoma (CCA) remain unknown. This study is to determine CCA mortality trends and variation based on national data.
  
  
  METHODS
  This nation-wide study was based on the underlying cause of death data collected by the National Center for Health Statistics (NCHS) between 1999 and 2014. The Center for Disease Control (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) system was used to obtain data. ICC and extra-hepatic CCA (ECC) were defined by ICD-10 diagnosis codes. Age-adjusted mortality rate was standardized to the US population in 2000.
  
  
  RESULTS
  There were more than 7000 CCA deaths each year in the US after 2013. CCA mortality for those aged 25+ increased 36 % between 1999 and 2014, from 2.2 per 100,000 (95 % confidence interval [CI] 2.1-2.3) to 3.0 per 100,000 (95 % CI, 2.9-3.1). Mortality rates were lower among females compared with males (risk ratio [RR] 0.78, 95 % CI 0.77-0.79). Asians had the highest mortality. Between 2004 and 2014, the increase in CCA mortality was highest among African Americans (45 %) followed by Asians (22 %), and whites (20 %).
  
  
  CONCLUSIONS
  Based on the most recent national data, CCA mortality rates have increased substantially in the past decade. Among different race/ethnic groups, African Americans have the highest increase in CCA mortality.
authors.affiliation: West Windsor Plainsboro High School South, Plainsboro, NJ, 08550, USA.
authors.forename: Kaelan J
authors.initials: KJ
authors.lastname: Yao
authors.affiliation: Division of Radiation Oncology, The Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA.
authors.forename: Salma
authors.initials: S
authors.lastname: Jabbour
authors.affiliation: College of Global Public Health & Population Health, Langone School of Medicine, New York University, New York, NY, 10003, USA.
authors.forename: Niyati
authors.initials: N
authors.lastname: Parekh
authors.affiliation: Biometrics Division, The Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA.
authors.forename: Yong
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Division of Medical Oncology, The Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA. mossr1@cinj.rutgers.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Moss
keywords: Cholangiocarcinoma; Mortality; Time trends