S2467 Rising Rates of Hepatocellular Carcinoma Mortality in the United States From 1999 to 2024: A Comprehensive 25-Year Analysis by Demographic, Regional, and Urbanization Factors

Introduction: Hepatocellular carcinoma (HCC) mortality has been rising in the United States, yet contemporary data on how these trends vary by sex, race/ethnicity, region, and urbanization are limited. We aimed to characterize changes in age-adjusted mortality rates (AAMRs) of HCC from 1999 to 2024 using nationwide surveillance data. Methods: We obtained data on HCC deaths (n = 234,528) from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (DC WONDER) database for the period 1999–2024 with by its International Classification of Diseases, Tenth Revision code (C22.0). AAMRs were calculated per 100,000 population, age-adjusted to the 2000 U.S. standard population. Joinpoint regression analysis was used to identify significant trend segment changes and estimate segment-specific annual percent changes (APCs) and overall average annual percent changes (AAPCs). Results: Mortality rates due to HCC have increased from 1.86 (95% CI: 1.80 to 1.91) in 1999 to 2.92 (2.87 to 2.97) in 2024 (AAPC: 1.83%, 95% CI: 1.69 to 1.97). Throughout the period, men consistently exhibited higher mortality rates than women, with rates of 4.79 versus 1.34 in 2024, respectively. Although White patients maintained the lowest AAMR over the 25 years, they experienced the most rapid increase (AAPC: 2.18%, 95% CI: 2.04 to 2.3) among racial/ethnic groups. Regionally, the South exhibited the highest 2024 AAMR (3.18), with an AAPC of 2.25%. The AAMR gap between rural and urban areas is closing, and rural areas had a more pronounced increase (1.34 to 2.72, APC: 3.63%) compared to the urban areas (AAMR 1.99 to 2.78, AAPC: 1.56%). Even though some subpopulations have experienced reversals, deceleration, or stabilization in trends, the overall mortality from HCC continues to increase. Conclusion: HCC mortality continues to rise across the United States, with marked disparities by sex, race/ethnicity, region, and urbanization status. These findings underscore the urgent need for targeted prevention strategies, improved screening, and equitable access to care, particularly for high-risk populations and rural communities, to mitigate the growing burden of HCC.