Temporal Trends and Disparities in Hepatitis-B Mortality in the United States Between 1999-2020: A CDC WONDER Study

Aim To determine trends and disparities in hepatitis-B mortality in American adults older than 25 years between 1999–2020. Methods Retrospective analysis of CDC’s WONDER database was performed. For hepatitis-B, ICD-10 codes B16.0-16.2, B16.9, B17.0, B18.0, B18.1 were employed. Age-adjusted mortality rates(AAMR) and crude death rates(CDR) per 100,000 persons were determined. Average annual percentage change(AAPC) was determined using Joinpoint regression. Results 38,845 deaths were reported. AAMRs declined sharply from 1.12–0.87 between 1999–2004(AAPC:-4.45;p < 0.001) followed by a steady decline from 0.87 − 0.69(AAPC:-1.64;p < 0.001), resulting in an overall AAMR of 0.82(AAPC:-2.31;p < 0.001). Males had disproportionately higher AAMR(1.28) than females(0.41) and showed a greater decline(AAPC:-2.62;p < 0.001) than females(AAPC:-2.13;p < 0.001). Among races, non-Hispanic(NH) Asian/Pacific Islanders had disproportionately higher AAMRs(4.04) followed by NH Blacks(1.45), NH American Indians/Alaskan Natives(0.9), Hispanic(0.71), and NH Whites(0.55). All races saw declines in AAMR, with greatest decline seen in Hispanic(AAPC:-6.43;p < 0.001). Geographically, AAMRs were highest in West(1.17) followed by South(0.83). All census regions saw declines in AAMR, with greatest decline seen for Northeast(AAPC:-3.38;p < 0.001). Metropolitan areas had higher AAMR(0.84) than nonmetropolitan areas(0.59) and saw greater decline in AAMR(AAPC:-2.86;p < 0.001) than nonmetropolitan areas(AAPC:-0.55;p = 0.059). Of the 10-year age groups, CDR was highest for 55–64 years(1.46). The age groups of 25–34, 35–44, 45–54, and 55–64 years saw declining AAMRs, with greatest decline seen for 35–44 years(AAPC:-5.64;p < 0.001). However, 65–74, 75–84, and 85 + years saw an increase in AAMRs, with greatest increase seen for 85 + years(AAPC:1.12;p = 0.037). Conclusion We found a significant decline in hepatitis-B mortality, though persistent disparities exist. Elderly males, NH Asian/Pacific Islanders, residents of West and metropolitan areas experienced disproportionately higher mortality rates.