Liver Cancer Deaths Rising Faster Among Less Educated Adults

Roxanne Nelson, RN, BSN

April 16, 2019

Rates of death from liver cancer have been rising in the United States, but the rise appears to be largely limited to less educated persons, especially among men, according to a new analysis from the American Cancer Society.

From 2000-2015, the overall mortality rate from liver cancer (per 100,000 persons) increased from 7.5 to 11.2 in men and from 2.8 to 3.8 in women, but the increase was "generally steeper" in less educated groups for women and was "confined" to men with less than 15 years of education (ie, not college graduates), report the authors, led by Jiemin Ma, PhD, from the Surveillance and Health Services Research Program at the American Cancer Society.

The authors also report that this education disparity in liver cancer death rates increased until 2006 and then leveled off in women; it continued, however, to increase from 3.49 to 7.74 in men, with the increase more pronounced for hepatitis C virus (HCV)-related liver cancer than liver cancer unrelated to HCV.

The researchers also found that even though mortality rates were rising faster for cancers associated with HCV infection, the overall liver cancer mortality trends were primarily driven by liver cancers that were unrelated to HCV.

"Classifying liver cancer deaths into HCV-related and HCV-unrelated groups allowed us to more thoroughly understand the recent pattern of liver cancer mortality," said Ma.

The risk factors for HCV-unrelated liver cancers include obesity, diabetes, smoking, and excessive alcohol consumption.

The study was published online April 8 in Cancer.

Liver cancer is the most rapidly rising cause of cancer deaths in the United States, and mortality rates have doubled since the mid-1980s. Rates are rising faster than for any other cancer type, with 30,200 deaths estimated for 2018.

Lower Education Linked to Rising Rates

In this study, Ma and colleagues analyzed mortality data published by the National Vital Statistics System of the National Center for Health Statistics from 2000-2015. They looked specifically at trends in death rates from liver cancer by individual-level educational attainment, HCV-infection status, race/ethnicity, and sex among persons ages 25 to 74 years.

For men, the overall liver cancer death rate (per 100,000 persons) rose during the study period by 48.6% (from 7.52 to 11.18),

Among women, the patterns were similar. Overall mortality rates for liver cancer increased by 34.7%, from 2.82 in 2000 to 3.80 in 2015, and the death rates rose faster for HCV-related disease than those unrelated. Mortality was also greater among less educated women than those with 16 or more years of education.

But after 2006, the death rate from HCV-unrelated liver cancer increased by 3.09% per year among women with a higher education (16 or more years of schooling), and this rate is comparable to the trends observed among those with less education.

The authors also found that the increase in liver cancer death rates occurred in all three major racial/ethnic groups that were included in this study (non-Hispanic white, non-Hispanic black, Hispanic). The rate of increase, however, was steeper for non-Hispanic whites vs non-Hispanic blacks or Hispanics.  For example, mortality rates (per 100,000 persons) in men rose from 5.95 to 9.45 among non-Hispanic whites, from 13.24 to 18.06 among non-Hispanic blacks, and from 11.24 to 13.49 among Hispanics.

"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," said Ma. "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."

The study was supported by the Intramural Research Department of the American Cancer Society. All the authors are employed by the American Cancer Society and work in the Intramural Research Department, which received a grant from Merck.

Cancer. Published online April 8, 2019. Abstract

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