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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatocellular carcinoma national burden across different geographical regions in the United States between 2001 and 2020
Yazan Abboud, Raj Malhotra, Muhammad Hassaan Arif Maan, Anna Mathew, Ibrahim Abboud, Chun-Wei Pan, Saqr Alsakarneh, Fouad Jaber, Islam Mohamed, David Kim, Nikolaos T Pyrsopoulos
Yazan Abboud, Raj Malhotra, Muhammad Hassaan Arif Maan, Anna Mathew, David Kim, Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ 07103, United States
Ibrahim Abboud, University of California Riverside School of Medicine, Riverside, CA 92521, United States
Chun-Wei Pan, Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL 60612, United States
Saqr Alsakarneh, Fouad Jaber, Islam Mohamed, Department of Internal Medicine, University of Missouri-Kansas City, Kansas, MO 64108, United States
Nikolaos T Pyrsopoulos, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07101, United States
Co-corresponding authors: Yazan Abboud and Nikolaos T Pyrsopoulos.
Author contributions: Abboud Y designed the study, conducted the acquisition, analysis, and interpretation of data for the study; and drafted the manuscript; Malhotra R, Maan MHA, Mathew A, Abboud I drafted parts of the manuscript and revised the manuscript critically for important intellectual content; Pan CW, Alsakarneh S, Jaber F, Mohamed I, and Kim D revised the manuscript critically for important intellectual content; Pyrsopoulos NT supervised the work; contributed to the design of the study, and revised the manuscript critically for important intellectual content. All Authors have read and approved the manuscript. Abboud Y and Pyrsopoulos NT are co-corresponding authors because both authors contributed equally to the study conception, design, and methodology. While Abboud Y was responsible for data access, and conducting the statistical analysis, Pyrsopoulos NT supervised the work and reviewed the methods and results critically for important intellectual input. Abboud Y drafted the original version of the manuscript, and Pyrsopoulos NT edited the manuscript and reviewed it critically for important intellectual input. Abboud Y has access to the data used in the study and he is the lead author and will be able to reply to any correspondence or question raised, if any, in the future. Pyrsopoulos NT is the article senior author and is the most experienced author among the author list with extensive experience in the topic of the manuscript and can help in any future correspondence as well.
Institutional review board statement: Data used in this study were all publicly available and de-identified and therefore were exempted from review by the institutional review board, based on the National Human Research Protections Advisory Committee Policy.
Informed consent statement: Data used in this study were all publicly available and de-identified and therefore were exempted from review by the institutional review board, based on the National Human Research Protections Advisory Committee Policy.
Conflict-of-interest statement: The findings of this study were accepted to be presented at the Digestive Diseases Week 2024 conference at the “Liver and Biliary Tract Carcinoma (Hepatobiliary Neoplasia)” session on May 20th, 2024 (12:30 PM to 1:30 PM), in Washington, D.C.
Data sharing statement: Data used in this study were all publicly available and can be obtained from the United States Cancer Statistics Database.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yazan Abboud, MD, Doctor, Department of Internal Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, United States.yazanabboud.md@gmail.com
Received: April 13, 2024
Revised: May 12, 2024
Accepted: June 3, 2024
Published online: December 20, 2024
Processing time: 103 Days and 15.9 Hours
BACKGROUND
While prior data showed an increasing incidence of hepatocellular carcinoma (HCC) in the United States, there are limited comprehensive and comparative data on the geographical variations of HCC trends in different demographic-specific populations.
AIM
To evaluate sex and age-specific incidence rates and time trends in different geographical regions in the United States.
METHODS
Age-adjusted HCC incidence rates were collected from the United States Cancer Statistics (USCS) database which covers approximately 98% of the population in the United States. HCC rates were stratified by sex, age, and geographical region. annual percentage change (APC) and average APC (AAPC) were estimated using Joinpoint Regression. A pairwise comparison was conducted between sex-specific trends.
RESULTS
There were 467344 patients diagnosed with HCC in the United States in the USCS database between 2001 and 2020. The rates and trends varied by geographical region. When looking at the West region (115336 patients), incidence rates of HCC were overall increasing and also increasing in older adults. However, when evaluating younger adults, HCC incidence rates decreased in men but not in women with a sex-specific absolute AAPC-difference of 2.15 (P = 0.005). When evaluating the Midwest region (84612 patients), similar results were seen. While incidence rates were increasing in the overall population and in older adults as well, they were decreasing in younger men but not in women with a sex-specific absolute AAPC-difference of 1.61 (P < 0.001). For the Northeast region (87259 patients), the analysis showed similar results with decreasing HCC incidence rates in younger men but not counterpart women (Sex-specific AAPC-difference = 3.26, P < 0.001). Lastly, when evaluating the south (180137 patients), the results were also decreasing in younger men but not in women (Sex-specific AAPC-difference = 2.55, P < 0.001).
CONCLUSION
Nationwide analysis covering around 98% of the United States population shows an increasing incidence of HCC across all geographical regions, most notably in the South. While younger men experienced decreasing HCC incidence, younger women had a stable trend and this was noted across all regions as well. Our study offers insight into the epidemiology of HCC in different demographic groups across various United States geographical regions. While the reasons contributing to our findings are unclear, they can be related to sex and regional disparities in healthcare access and utilization. Future research is warranted to characterize the temporal change in HCC risk factors across different United States regions.
Core Tip: In this retrospective study of the United States Cancer Statistics database (which covers approximately 98% of the United States population), we analyzed sex and age-specific hepatocellular carcinoma (HCC) incidence across different United States regions between 2001-2020. HCC incidence rates were significantly increasing in the West, Midwest, Northeast, and South of the United States, most notably in the South. While younger men experienced decreasing HCC incidence, younger women had non-decreasing incidence, and this was noted across all regions. While this can be due to regional disparities in healthcare access/utilization, future research is needed to investigate regional HCC risk factors, especially in younger adults.
