Hepatocellular carcinoma national burden across different geographical regions in the United States between 2001 and 2020

BACKGROUND While prior data showed an increasing incidence of hepatocellular carcinoma(HCC)in the United States,there are limited comprehensive and comparative data on the geographical variations of HCC trends in different demographicspecific populations.AIM To evaluate sex and age-specific incidence rates and time trends in different geographical regions in the United States.METHODS Age-adjusted HCC incidence rates were collected from the United States Cancer Statistics(USCS)database which covers approximately 98%of the population in the United States.HCC rates were stratified by sex,age,and geographical region.annual percentage change(APC)and average APC(AAPC)were estimated using Joinpoint Regression.A pairwise comparison was conducted between sex-specific trends.RESULTS There were 467344 patients diagnosed with HCC in the United States in the USCS database between 2001 and 2020.The rates and trends varied by geographical region.When looking at the West region(115336 patients),incidence rates of HCC were overall increasing and also increasing in older adults.However,when evaluating younger adults,HCC incidence rates decreased in men but not in women with a sex-specific absolute AAPC-difference of 2.15(P=0.005).When evaluating the Midwest region(84612 patients),similar results were seen.While incidence rates were increasing in the overall population and in older adults as well,they were decreasing in younger men but not in women with a sex-specific absolute AAPC-difference of 1.61(P<0.001).For the Northeast region(87259 patients),the analysis showed similar results with decreasing HCC incidence rates in younger men but not counterpart women(Sex-specific AAPC-difference=3.26,P<0.001).Lastly,when evaluating the south(180137 patients),the results were also decreasing in younger men but not in women(Sex-specific AAPC-difference=2.55,P<0.001).CONCLUSION Nationwide analysis covering around 98%of the United States population shows an increasing incidence of HCC across all geographical regions,most notably in the South.While younger men experienced decreasing HCC incidence,younger women had a stable trend and this was noted across all regions as well.Our study offers insight into the epidemiology of HCC in different demographic groups across various United States geographical regions.While the reasons contributing to our findings are unclear,they can be related to sex and regional disparities in healthcare access and utilization.Future research is warranted to characterize the temporal change in HCC risk factors across different United States regions.