Trends in the Mortality of Hepatocellular Carcinoma in the United States

  • Eliza W. Beal
  • Dmitry Tumin
  • Ali Kabir
  • Dimitrios Moris
  • Xu-Feng Zhang
  • Jeffery Chakedis
  • Kenneth Washburn
  • Sylvester Black
  • Carl M. Schmidt
  • Timothy M. Pawlik
Original Article

Abstract

Introduction

Primary liver cancer mortality rates have been increasing in the US, but reported decreases among 35–49 year olds may foreshadow future declines. We sought to use age-period-cohort (APC) modeling to evaluate the contribution of cohort effects to hepatocellular carcinoma (HCC) mortality trends in the US.

Methods

Data on HCC mortality were obtained from the Centers for Disease Control and Prevention National Center for Health Statistics WONDER Online Multiple Cause of Death database, 1999–2015. Crude mortality rates were plotted by gender and age at death. Gender-specific restricted cubic spline APC models were fit to determine influence of birth cohort on incidence of HCC mortality, in reference to the 1940 birth cohort.

Results

Highest mortality rates were found among men ages 70+, with steepest increase in mortality observed among men 55–69 years old. Similar trends were found among females. Accounting for the cohort effect in the APC model markedly improved model fit (likelihood ratio test p < 0.001). Relative to the 1940 birth cohort, risk of mortality due to HCC was significantly higher in later as well as earlier cohorts.

Conclusions

HCC-associated mortality continues to increase, secondary to an increase in the risk of HCC-associated mortality in more recent birth cohorts among both men and women.

Keywords

Hepatocellular carcinoma Mortality 

Abbreviations

ALD

Alcoholic liver disease

APC

Age-period-cohort

HCC

Hepatocellular carcinoma

HBV

Hepatitis B Virus

HCV

Hepatitis C Virus

MELD

Model for end stage liver disease

NASH

Nonalcoholic steatohepatitis

NAFLD

Nonalcoholic fatty liver disease

US

United States

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Eliza W. Beal
    • 1
  • Dmitry Tumin
    • 2
  • Ali Kabir
    • 1
  • Dimitrios Moris
    • 1
  • Xu-Feng Zhang
    • 1
    • 3
  • Jeffery Chakedis
    • 1
  • Kenneth Washburn
    • 3
  • Sylvester Black
    • 3
  • Carl M. Schmidt
    • 1
  • Timothy M. Pawlik
    • 1
    • 4
  1. 1.Department of Surgery, Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research InstituteColumbusUSA
  2. 2.Department of Anesthesiology and Pain MedicineNationwide Children’s HospitalColumbusUSA
  3. 3.Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and EngineeringFirst Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  4. 4.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA

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