S2501 A Comparative and Descriptive Analysis of Non-Viral Liver Cancer Trends in the US From 1999–2020

Introduction: Non-viral liver cancer, particularly hepatocellular carcinoma (HCC), accounts for 90% of liver cancer cases and is the sixth most common cancer globally. With the advent of vaccines and therapeutic measures viral HCC has declined. However, non-viral etiologies such as nonalcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD) are on the rise. At a population level, we aimed to evaluate temporal trends in non-viral HCC mortality across U.S. populations, focusing on demographic and regional disparities. Methods: We conducted a retrospective analysis of the 1999-2020 CDC WONDER mortality data (n = 136,101,150). Joinpoint regression assessed the temporal trends in liver cancer mortality in the age-adjusted mortality rates stratified by sex, race (White, Black, Asian/Pacific Islander), and Health and Human Services (HHS) regions. The Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals (CI) and P-values were calculated. Results: White men aged 55-64 consistently exhibited the highest liver cancer mortality rates across all HHS regions, with woman rates remaining approximately 1 per 100,000. HHS Region 9 had the highest overall liver cancer mortality rate at 23.3%, with a significant APC of 10.42% (95% CI: 8.34–13.10). Region 4 and Region 6 followed at 15.7% and 14.7%, respectively. In Region 9, man liver cancer mortality increased from 2007–2017 (7.5%; 95% CI: 3.6–31.2; P = 0.015). Region 6 men experienced a significant rise from 2000–2015 (12.6%; 95% CI: 10.1–17.9; P < 0.001), followed by a decline from 2015–2020 (APC -6.7%; 95% CI: -30.3 to 4.4; P = 0.20). Black men in Regions 3 and 6 showed rising trends with APCs of 5.83% (95% CI: 0.53–11.27) and 6.77% (95% CI: 3.85–9.84), respectively. In contrast, Asian/Pacific Islander men in Region 9 demonstrated a non-significant decrease (APC -4.21%; 95% CI: -9.51 to 1.46). Conclusion: Non-viral liver cancer mortality has been rising disproportionately among older White and Black men in several U.S. regions, notably HHS Regions 6 and 9 over the last 2 decades. This correlates with the trend of nonalcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD). Factors contributing are multifactorial, gender disparities, socioeconomic disparities. Recommended intervention are aspirin, statins, lifestyle modifications, and increased surveillance. There is an increased need for public health intervention in at-risk groups mainly the man population.