Rates of Hepatocellular Carcinoma Cases Slow in Urban Areas, Increase in Rural Areas Since 2009

A recent study found that rural non-Hispanic whites and blacks have experienced increased HCC case incidence rates, while urban areas have seen the rate decline since 2009.

When rural and urban new hepatocellular carcinoma (HCC) cases are compared by specific demographic factors, the rate of HCC cases has slowed since 2009 in urban areas, while rural non-Hispanic whites and Blacks have experienced the greatest increase in cases over that time, according to a study presented at The Liver Meeting Digital Experience.

The study compared HCC incidence trends over a 20-year period to gain insight into the HCC health disparities between rural and urban areas.

“Rural Americans face considerable disadvantages when it comes to health access and outcomes. Those that live in rural areas also have higher rates of smoking, excessive drinking, obesity and lower levels of physical activity, all of which can increase the risk for HCC,” study co-author, Christina Gainey, MD, at Los Angeles County-USC Medical Center in Los Angeles, said in a press release. “As nearly one in five Americans lives in a rural area, health disparities in this population represent a critical public health issue.”

The researchers utilized the North American Association of Central Cancer Registries dataset to calculate the age-adjusted HCC incidence rate of over 310,000 cases. The comparisons between rural and urban populations were made by sex, race/ethnicity and region and the team calculated the average annual percentage changes from 1995-2016.

Of the 310,635 HCC cases analyzed, 85% were in urban areas and 15% were in rural areas. The age-adjusted HCC incidence rates were found to be lower in rural areas compared to urban areas, but average percentage change taken annually was higher in rural areas. Specifically, the increasing incidence rates in urban areas slowed, with an average annual increase of 5.3% before 2009, but only an average increase of 2.7% from 2009-2016.

More, the researchers found that rural non-Hispanic whites saw the largest incidence rate increase over the 20-year period, while urban non-Hispanic blacks saw the largest single segment incidence rate growth between 1999-2009. The only racial/ethnic group that saw a decline in their overall incidence rates was urban Asians/Pacific Islanders.

“Our study is the first to show that new cases of HCC are disproportionately affecting individuals living in rural America,” said Gainey in a press release. “It is imperative for us to focus our efforts in this vulnerable population to slow the rapid rise in new cases. Our next steps will be to study the drivers of these health disparities to better inform cancer-reducing interventions.”

For the study, urban was defined as areas with populations ranging from 2500-49,999, while rural areas were defined with a population of fewer than 2500 people.

HCC is the most common type of liver cancer, with incidence rates continuing to rise in the United States. Researchers from California were curious to know if the disparities for other cancer types in rural areas were similar to incidence rates in urban locales.


New Cases of Hepatocellular Carcinoma Disproportionately Affecting Americans in Rural Areas New Study Shows [news release]. Alexandria, Virginia. Published November 10, 2020. https://www.newswise.com/articles/new-cases-of-hepatocellular-carcinoma-disproportionately-affecting-americans-in-rural-areas-new-study-shows?sc=dwhr&xy=10019792. Accessed November 24, 2020.

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