A recent study reveals that rising rates of liver cancer death in the United States have largely been confined to individuals who have received less education, especially among men.1 The findings emphasize the need for enhanced efforts to address the growing burden of liver cancer among lower socioeconomic groups.

Liver cancer, which in some cases is caused by infection with hepatitis C virus (HCV), is the most rapidly rising cause of cancer death in the United States. Previous studies have examined varying trends in liver cancer mortality, but there have been no studies examining recent national trends by individual-level socioeconomic status or HCV-infection status.

To investigate these questions, Jiemin Ma, PhD, MHS, of the American Cancer Society, and his colleagues analyzed mortality data published by the national vital statistics system of the National Center for Health Statistics from 2000 through 2015. The team looked specifically at trends in death rates from liver cancer by individual-level educational attainment, HCV-infection status, race/ethnicity, and sex, among persons aged 25–74 years.

From 2000 through 2015, the overall liver cancer death rate per 100,000 persons increased from 7.5 to 11.2 in men and from 2.8 to 3.8 in women, with the increase largely confined to individuals with less educational attainment. The educational disparities related to liver cancer mortality widened among women until 2006, and then leveled off; but among men, the disparities continued to widen. Although death rates increased faster for HCV-related than HCV-unrelated liver cancers, overall liver cancer mortality trends were largely driven by HCV-unrelated liver cancers.

“Classifying liver cancer deaths into HCV-related and HCV-unrelated groups allowed us to more thoroughly understand the recent pattern of liver cancer mortality,” says Ma. Risk factors for HCV-unrelated liver cancers include diabetes, obesity, smoking, and excessive alcohol consumption.

“To our knowledge, this study is among the first to examine the recent trends in liver cancer death rates by individual-level education and by HCV-infection status,” Ma adds. “Our findings underscore the need for enhanced and targeted efforts in lower socioeconomic groups to halt and reverse the undue growing burden of liver cancer.”


  1. Ma J, Siegel RL, Islami F, Jemal A. Temporal trends in liver cancer mortality by educational attainment in the United States, 2000–2015. Cancer. Epub before print, April 8, 2019; doi: 10.1002/cncr.32023.

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