S2720 Alcoholic Liver Disease–Related Hepatocellular Carcinoma in the US: A 25-Year Mortality Analysis (1999–2023)

Introduction: Hepatocellular carcinoma (HCC) is one of the most common cancers in the U.S., and Alcohol-associated liver disease (ALD) is emerging as a major driver of hepatocellular carcinoma. In 2022, ALD accounted for 29.8% of all HCC-related deaths, a substantial increase compared to earlier years. Our study aims to assess the temporal trends in ALD-related HCC mortality among US citizens by age, gender, and race. Methods: We used CDC WONDER data to examine age-adjusted mortality rates (AAMR) for ALD-related HCC in the U.S. from 1999 to 2023. Trends were analyzed using Joinpoint regression to calculate annual and average annual percent changes (APC and AAPC), with 95% confidence intervals estimated by the parametric method. Statistical significance was assessed using a parallelism test (P < 0.05). Results: From 1999 to 2023, ALD-related HCC caused a total of 801,200 deaths in the US. The overall AAMR for ALD-related HCC carcinoma in 1999 was 7.7 (95% CI: 7.6 to 7.8) and increased to 16.1 (95% CI: 16 to 16.2) in 2023 with an AAPC of 3.95% (95% CI: 3.64 to 4.48), exhibiting an increasing trend. Men showed a higher AAMR as compared to women from 1999 to 2023 (12.4 vs 3.6) and (23.5 vs 9.4). AAPC was higher among women. According to the racial distribution, American Alaskans showed the highest mortality (AAMR: 31.76), followed by Hispanics or Latinos (16.13), White Americans (11.57), Blacks or African Americans (10.46), and Asians or Pacific Islanders (8.51). Regional analysis also revealed disparities in AAMR, with the West having the highest AAMR of 16.69, followed by the South (10.36), the Midwest (10.15), and the Northeast (8.53). The states with AAMRs were Wyoming, Alaska, Washington, and California. Metropolitan regions demonstrated a higher AAMR 11 (11-11) compared to non-metropolitan regions, with 10.8 (10.8-10.9). Non-metropolitan regions demonstrated an overall increasing trend with an AAPC of 5.09%. Conclusion: Alcoholic liver disease is one of the important causes of HCC-related mortality in the U.S. A constant increase in the overall mortality rate from 1999 to 2023 is very concerning and needs policy changes regarding alcoholism and improved quality care for HCC patients. The disproportionate significantly increased mortality rates among American Indians or Alaska Natives also require further investigations to identify the cause.