Analysis of hospital incidence and direct medical costs of intrahepatic cholangiocarcinoma in Spain (2000-2018)

Trends and Disparities in Intrahepatic Cholangiocarcinoma-related Mortality in the United States from 1999 to 2020

PURPOSE

Intrahepatic cholangiocarcinoma (ICC) arises from the epithelial cells of the bile ducts present inside the liver parenchyma and is associated with an overall poor prognosis due to advanced disease stage at the time of diagnosis. We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to determine ICC-related mortality patterns in the United States from 1999 till 2020.

METHODS

Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) were extracted from the CDC WONDER database. Annual percentage change (APC) was calculated using Joinpoint regression.

RESULTS

Our analysis of ICC-related deaths revealed a consistent upwards trend from 1999 to 2020 in the United States (APC: 3.59, 95% CI: 3.34 to 3.83, p < 0.05). AAMR remained higher in males (1.7, 95% CI: 1.6 to 1.7) than females in (1.3, 95% CI: 1.3 to 1.3). Upon stratification by geographical distribution, we observed the highest mortality rate in the Northeast region (AAMR: 1.6, 95% CI: 1 to 2) and urban areas (1.4, 95% CI: 1.3 to 1.5). The highest ICC-related AAMR was observed in Hawaii, Rhode Island, and Washington, with mortality rates being twice as high as states at the lower end of the spectrum, including Mississippi and Arkansas. Non-Hispanic Asian or Pacific Islanders exhibited the highest AAMR (1.9, 95% CI: 1.9 to 2) as compared to other racial groups, and adults aged ≥ 85 years exhibited the highest CMR (11.2, 95% CI: 10.3 to 12.1).

CONCLUSION

The rise in ICC-related deaths from 1999 to 2020 is concerning, with the AAMRs observed to be the highest in males, non-Hispanic Asian or Pacific Islanders, adults aged ≥ 85 years and residents of the Northeast region, urban areas, and Hawaii. Efforts must be directed towards vulnerable populations to decrease ICC-related mortality.

The Humanistic and Economic Burden of Alzheimer's Disease

Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in older individuals (aged ≥ 65 years) throughout the world. As a result of these progressive deficits in cognitive, emotional, and physical function, AD dementia can cause functional disability and loss of independence. To gain a deeper understanding of the recent literature on the burden of AD, including that of mild cognitive impairment (MCI) due to AD, we conducted a comprehensive targeted review of the PubMed-indexed literature (2014 to 2021) to examine the humanistic and economic burden of AD (including MCI) in North America, Europe, and Asia. Our literature review identified a range of factors associated with quality of life (QoL): some factors were positively associated with QoL, including caregiver relationship, religiosity, social engagement, and ability to engage in activities of daily living (ADL), whereas other factors such as neuropsychiatric symptoms were associated with poorer QoL. While patient- and proxy-rated QoL are highly correlated in patients with early AD dementia, proxy-rated QoL declines more substantially as severity worsens. The maintenance of self-reported QoL in patients with more severe AD dementia may be due to lack of awareness or to adaptation to circumstances. Compared to persons with normal cognition, MCI is associated with a greater cost burden, and individuals with MCI exhibit worse QoL. Key drivers of the societal economic burden of AD include disease severity, dependence level, institutionalization, and comorbidity burden. Evaluation of the impact of a hypothetical disease-modifying treatment delaying the progression from MCI to AD has suggested that such a treatment may result in cost savings.