Evaluating Disparities for Non-Hodgkin Lymphoma Associated with Chronic Hepatitis C in the United States Vs Texas (1999-2020)
Authors: Naz Sidra , Yousaf Muhammad Sheraz , Taqdees Aqsa , Jose Thulasee 
Published: December 2024

Introduction: Hepatitis C (HCV) prevalence among patients with non-Hodgkin lymphoma (NHL) is around 15%, significantly higher than the general population (1.5%) and patients with other hematologic malignancies (2.9%). This indicates a potential role of HCV in the development of NHL. This study aims to analyze annual mortality trends and sociodemographic factors of NHL associated with HCV infection in the United States and Texas from 1999 to 2020. The goal is to explore public health initiatives and development of specifically directed prevention and treatment strategies.

Methods: The mortality trends among adults aged ≥25 with NHL due to chronic HCV infection were analyzed using data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database, where HCV and NHL were presented as a contributing or the underlying cause of death. Code B18.2 “Chronic viral hepatitis C” and Code C85.9 “Non-Hodgkin Lymphoma” in the International Classification of Disease, tenth revision (ICD-10) were used to identify the data. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joint point regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups.

Results: Between 1999 and 2020, 644364 documented deaths were attributed to HCV-associated NHL. The overall AAMR for HCV-associated NHL-related mortality increased in the US from an adjusted rate (AR) 13.5 in 1999 to 15.8 in 2005 (APC: -3.45%; 95% CI: -4.10% to -2.75%), after which it decreased to 10.4 in 2018 (APC: -6.01%; 95% CI: -7.13% to -3.64%) then it decreased further to 9.6 in 2020 (APC: -1.58%; 95% CI: -5.96% to 0.63%). In Texas AAMR for HCV-associated NHL-related mortality decreased from AR 13.2 in 1999 to 10.7 in 2003 (APC: -5.88%; 95% CI: -14.33% to -1.40%) after which it increased to 18.2 in 2006 (APC: 20.84%; 95% CI: 11.87% to 26.11%) and then decreased to 16.2 in 2015 (APC: -1.19%; 95% CI: -2.55% to 0.50%). The AAMR in 2020 decreased to AR 10.8 (APC: -8.23%; 95% CI: -13.34% to -5.89%). Males had higher consistently higher AAMRs than females (13.6 vs. 6.3). The AAMR in the US men decreased from 17.2 in 1999 to 14.6 in 2003 (APC: -5.71%; 95% CI: -14.82% to -0.19%) after which it increased to 21.6 in 2006 (APC: 16.35%; 95% CI: 7.98% to 21.08%). The AAMR in 2014 in the US men decreased to 19.5 (APC: -1.29%; 95% CI: -2.87% to 0.44%) after which it decreased further to 13.6 in 2020 (APC: -6.88%; 95% CI: -11.02% to -5.29%). The AAMR in the US women decreased from 10.8 in 1999 to 9.3 in 2003 (APC: -4.51%; 95% CI: -10.86% to -1.70%) after which it increased to 11.6 in 2006 (APC: 8.55%; 95% CI: 4.19% to 11.51%). The AAMR in 2014 in the US women decreased to 9.6 (APC: -2.56%; 95% CI: -3.64% to -1.52%) after which it decreased further to 6.3 in 2020 (APC: -7.40%; 95% CI: -11.85% to -5.85%). The non-Hispanic (NH) American Indian or Alaska Native population has the greatest AAMR (19.2), followed by the NH Black or African American (AA) with an AAMR (11.8) and the Hispanic or Latino population with an AAMR (9.8). The low-risk population was the NH White population (9.6) and the NH Asian or Pacific Islander (4.8). AAMR also varied by region (overall AAMR: West: 11; South: 10.2; Midwest: 8.5; Northeast: 7.9) and non-metropolitan areas had higher AAMR (non-core areas: 10.6; micropolitan areas: 10.9) than metropolitan areas (large central metropolitan areas: 9.8; large fringe areas: 7.9). The states in the upper 90th percentile of HCV-associated NHL-related AAMRs were South Dakota, Nebraska, Kansas, Arkansas, Ohio, Pennsylvania, and New Jersey exhibited an approximately two-fold increase in AAMRs, compared to states falling in the lower 10th percentile.

Conclusions: The mortality rates from chronic hepatitis C-associated non-Hodgkin lymphoma have overall decreased in the United States and Texas over the past two decades. But NH American Indian or Alaska Native, NH Black or AA followed by Hispanic or Latino men, are at more risk than NH White and Asian or Pacific Islander.