Alcoholic liver disease-related hepatocellular carcinoma (HCC) mortality in the U.S. has risen by 412.5% over the past 25 years, with the greatest burden observed among adults aged 65 and older, women, non-Hispanic Whites, and Hispanics, a large analysis of public health data showed. 

The Midwest and South experienced the most rapid increases, while the West reported the highest overall rates.  

“Alcoholic liver disease (ALD) is a major contributor to chronic liver injury and a well-established risk factor for hepatocellular carcinoma,” presenting author Simran Joshi, MD, an internal medicine resident at Yale New Haven Health System, Conn., and colleagues wrote in a poster abstract presented during the annual meeting of the American Association for the Study of Liver Diseases. “With rising alcohol consumption and earlier onset of liver dysfunction, ALD-driven HCC poses a growing public health concern in the United States. However, national-level mortality trends in ALD-associated HCC, particularly among older adults, remain underexplored.” 

The researchers used Joinpoint regression to analyze 25-year mortality trends of ALD-related HCC in U.S. adults aged 45 and older from the CDC WONDER database between 1999 and 2023. They calculated age-adjusted mortality rates (AAMRs) per million, along with the average annual percent change (AAPC) and corresponding 95% confidence intervals. 

Over the 25-year study period, ALD-associated HCC was responsible for 16,729 deaths. Between 1999 and 2023, the AAMR rose from 0.08 to 0.41 per 100,000, marking a 412.5% increase (AAPC: 6.86). The rate of increase was more substantial in females than in males (females: AAPC 8.05; males: AAPC 6.89). 

Among racial and ethnic groups, Hispanics or Latinos exhibited the highest AAMR (0.56), an 82.5% increase, while non-Hispanic Whites had an AAMR of 0.21, reflecting a 457.14% rise. Non-Hispanic Whites showed the most rapid growth in mortality (AAPC 8.07), followed by Hispanics or Latinos (AAPC 3.66). 

By region, the West had the highest mortality burden (AAMR: 0.41), followed by the South (AAMR: 0.22) and the Midwest (AAMR: 0.21). The Midwest experienced the fastest increase in mortality (AAPC: 8.77), with the South close behind (AAPC: 8.63). 

Finally, adults aged 65 and older consistently had higher mortality rates than those aged 45–64 (AAMR: 0.52 vs 0.43), with a steeper increase in the older group (AAPC: 7.58 vs 5.41). 

Source: AASLD