Trends in Hepatocellular Carcinoma Mortality Rates in the US and Projections Through 2040

Abstract

Importance: The burden of liver cancer varies worldwide. An upward trend in both hepatocellular carcinoma (HCC) incidence and mortality in the past 2 decades has been observed.

Objective: To assess observed HCC-related age-standardized mortality rates (ASMRs) in the US for 2006 to 2022 and provide ASMR projections through 2040.

Design, setting, and participants: This cross-sectional study used data from the National Vital Statistics System, which is accessible through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research website. Data on deaths attributed to HCC (from January 1, 2006, to December 31, 2022) were obtained for adults 25 years or older and were stratified by liver disease etiology, age, sex, and race and ethnicity. Etiologies included alcohol-associated liver disease (ALD), hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction-associated steatotic liver disease (MASLD).

Main outcomes and measures: The main outcomes were (1) observed ASMRs of HCC per 100 000 persons using Joinpoint regression (National Cancer Institute) to assess trends during 2006 to 2022 and (2) ASMRs projected for 2023 to 2040 using Prophet and AutoARIMA modeling.

Results: This study included 188 280 HCC-related deaths from 2006 to 2022. Most deaths occurred among males (77.4%). The annual percentage change was 4.1% (95% CI, 2.2% to 7.7%) for 2006 to 2009 and decreased to 1.8% (95% CI, 0.7% to 2.0%) for 2009 to 2022, with an overall observed ASMR of 5.03 per 100 000 persons in 2022 and a projected ASMR of 6.39 per 100 000 persons by 2040, with consistent trends for both sexes. By etiology, ASMRs decreased for HCV- and HBV-related mortality but increased for ALD- and MASLD-related mortality. In 2022, MASLD surpassed HBV as the third-leading cause of HCC-related death and was projected to overtake HCV in 2032 as the second-leading cause; ALD was projected to be the leading cause of HCC-related death in 2026. In 2022, the ASMR was higher among individuals aged 65 years or older compared with those aged 25 to 64 years (18.37 vs 1.79 per 100 000 persons). The American Indian or Alaska Native population had the largest increase in projected ASMR by 2040 (14.71 per 100 000 persons) compared with the Asian population (3.03 per 100 000 persons).

Conclusions and relevance: In this cross-sectional study, ASMRs for ALD- and MASLD-related HCC death increased rapidly from 2006 to 2022; ALD-related HCC was projected to be the leading cause by 2026, with MASLD as the second-leading cause by 2032. These findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC death.

Figure 1.. Cause of Death Related to Hepatocellular Carcinoma Presented by Age-Standardized Mortality Rate (ASMR) and Proportion by Different Etiologies

ALD indicates alcohol-associated liver disease; HBV, hepatitis B virus; HCV, hepatitis C virus; MASLD, metabolic dysfunction–associated steatotic liver disease.

Figure 2.. Observed and Projected Age-Standardized Mortality Rates (ASMRs) for Hepatocellular Carcinoma, Overall and by Sex, Age, Etiology, and Race and Ethnicity, 2006-2040

Shaded areas indicate 95% CIs. ALD indicates alcohol-associated liver disease; HBV, hepatitis B virus; HCV, hepatitis C virus; MASLD, metabolic dysfunction–associated steatotic liver disease.

Figure 3.. Observed and Projected Age-Standardized Mortality Rates (ASMRs) for Hepatocellular Carcinoma, by Sex, Age, and Etiology, 2006-2040

Projections for hepatitis C virus (HCV) to 2040 are based on data from 2015 to 2020. Projections for the other groups to 2040 are based on data from 2006 to 2022. Shaded areas indicate 95% CIs. ALD indicates alcohol-associated liver disease; HBV, hepatitis B virus; MASLD, metabolic dysfunction–associated steatotic liver disease.