Hepatocellular Carcinoma Incidence and Mortality in the USA by Sex, Age, and Race: A Nationwide Analysis of Two Decades

Background and Aims:While the incidence rates of hepa-tocellular carcinoma(HCC)are increasing,there are limited comprehensive data on demographic-specific incidence and mortality trends in the USA.We aimed to evaluate recent trends in HCC incidence and mortality among different de-mographic groups in the USA.Methods:Age-adjusted HCC incidence rates were calculated from the Centers for Disease Control's United States Cancer Statistics database,which combines incidence data on newly diagnosed cancer cases and covers approximately 98%of the population in the USA.Additionally,age-adjusted HCC mortality rates were obtained from the Centers for Disease Control's National Center for Health Statistics database,which offers comprehensive Cov-erage spanning nearly 100%of deaths attributed to HCC in the USA.Rates were stratified by sex,age(older[≥55 years]and younger[<55 years]adults),race and ethnicity(Non-Hispanic White,Non-Hispanic Black,Hispanic,Non-Hispanic Asian/Pacific Islander,and Non-Hispanic American Indian/Alaska Native),and tumor stage at diagnosis(early and late).Annual and average annual percentage change(AAPC)were calculated using joinpoint regression.A sex-specific pairwise comparison was conducted.Results:Between 2001 and 2020,there were 467,346 patients diagnosed with HCC(26.0%women),with increasing incidence in both sexes without significant difference(p=0.65).In younger adults(78,169 patients),the incidence decreased in men but not in women(AAPC difference=-2.39,p=0.002).This was seen in various racial and ethnic groups,mostly driven by early-stage tumors(AAPC difference=-2.65,p=0.02).There were 329,973 deaths attributed to HCC between 2000 and 2020(28.4%women).In younger adults(43,093 deaths),mortal-ity decreased in men at a greater rate than in women(AAPC difference=1.61,p=0.007).This was seen in various racial and ethnic groups,most notably in non-Hispanic American Indian/Alaska Natives(AAPC difference=-4.51,p=0.01).Conclusions:Nationwide USA data,covering nearly all HCC cases,show an increasing incidence and mortality over the last two decades.In younger adults,there was a decreas-ing incidence in men but not in women,due to early-stage tumors.Mortality improved in younger men at a greater rate than in women,especially in Non-Hispanic American Indian/Alaska Natives.Future studies are warranted to identify the risk factors associated with the occurrence and outcomes of HCC in demographic-specific populations,especially younger women.