
==== Front
Clin Transl Gastroenterol
Clin Transl Gastroenterol
CLTG
CT9
Clinical and Translational Gastroenterology
2155-384X
Wolters Kluwer Philadelphia, PA

CTG-24-0197
10.14309/ctg.0000000000000724
00013
3
Correspondence
Epidemiological Analysis on the Impact of Early COVID-19 Pandemic on Mortality for Hepatocellular Carcinoma in the United States
Mattiuzzi Camilla MD 1camilla.mattiuzzi@apss.tn.it

https://orcid.org/0000-0001-9523-9054
Lippi Giuseppe MD 2
1 Service of Clinical Governance, Provincial Agency for Social and Sanitary Services (APSS), Trento, Italy;
2 Section of Clinical Biochemistry, University of Verona, Verona, Italy.
Correspondence: Giuseppe Lippi, MD. E-mail: giuseppe.lippi@univr.it.
9 2024
12 7 2024
15 9 e1© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcWe read with interest the article by Liang et al (1), who reported that the early COVID-19 pandemic was associated with underdiagnosis of hepatocellular carcinoma (HCC) and underuse of HCC-directed treatment in the United States, thus raising the important question as to whether disruption of diagnostic and care pathways for HCC may have translated into a higher mortality for this type of cancer in the United States during the first period of the pandemic. To this end, we have planned this epidemiological analysis to address this important dilemma.

We searched the US Centers for Disease Control and Prevention (CDC) Wide-Ranging, Online Data for Epidemiologic Research (WONDER) online database (2), the most recent version of which reports mortality data for the entire US nation stratified by unique causes of death, areas, periods, and demographic variables, between 2018 and 2022. Our search was conducted for each year between 2018 and 2022, coupled with the specific International Classification of Diseases-10 code for HCC (C.22.0—Liver Cell Carcinoma). The mortality for HCC was downloaded as age-adjusted death rate (×100,000) and 95% confidence interval and statistically analyzed with one-way analysis of variance and the Tukey post hoc test. The study was conducted in accordance with the Declaration of Helsinki and in accordance with the terms of the relevant local legislation.

The outcomes of our search in the 2018–2022 CDC WONDER database are shown in Figure 1. The mortality for HCC in the United States throughout the study period remained almost unvaried, with just minor variations between the peak in 2018 (2.84 × 100,000) and troughs in 2019 and 2022 (2.78 × 100,000). Accordingly, both the mortality trend throughout 2018–2022 (f = 0.779; P = 0.538) and the multiple comparisons across different years (all P > 0.60) did not reach statistical significance by one-way analysis of variance and the Tukey post hoc test, respectively.

Figure 1. Mortality for hepatocellular carcinoma in the United States during the period 2018–2022 derived from data made available in the US Centers for Disease Control and Prevention (CDC) WONDER online database. Data are expressed as age-adjusted death rate ×100,000. The results of the statistical analysis are reported in the text of the manuscript. WONDER, Wide-Ranging, Online Data for Epidemiologic Research.

The results of our analysis of the 2018–2022 CDC-WONDER online database seemingly demonstrate that the early COVID-19 pandemic did not generate a substantial impact on the early mortality (i.e., within 2–3 years) for HCC in the United States Thus, the potential disruption of diagnostic and therapeutic pathway observed by Liang et al (1) did not seemingly translate into a negative effect on the death rate for this type of aggressive cancer.

CONFLICTS OF INTEREST

Guarantor of the article: Giuseppe Lippi, MD.

Specific author contributions: C.M., and G.L.: contributed to the conception, participated in the analysis and interpretation of data, and manuscript drafting.

Financial support: None to report.

Potential competing interests: None to report.
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REFERENCES

1. Liang J Lee YT Yeo YH . Impact of the early COVID-19 pandemic on incidence and outcomes of hepatocellular carcinoma in the United States. Clin Transl Gastroenterol. doi. 10.14309/ctg.0000000000000723
2. Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2022 on CDC WONDER Online Database, Released in 2024. Data Are from the Multiple Cause of Death Files, 2018-2022, as Compiled From Data Provided by the 57 Vital Statistics Jurisdictions Through the Vital Statistics Cooperative Program (http://wonder.cdc.gov/ucd-icd10-expanded.html). Accessed June 4, 2024.
