Hashem B. El-Serag, MD, MPH; Jessica A. Davila, PhD; Nancy J. Petersen, PhD; Katherine A. McGlynn, PhD
Grant Support: By the Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. Dr. El-Serag is a Veterans Affairs Health Services Research and Development Service Career Development awardee (RCD00-013-2).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Hashem B. El-Serag, MD, MPH, The Houston Veterans Affairs Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030; e-mail, email@example.com.
Current Author Addresses Drs. El-Serag, Davila, and Petersen: The Houston Veterans Affairs Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030.
Dr. McGlynn: National Cancer Institute, 6120 Executive Boulevard, Rockville, MD 20892-7234.
Author Contributions Conception and design: H.B. El-Serag.
Analysis and interpretation of the data: H.B. El-Serag, J.A. Davila, N.J. Petersen, K.A. McGlynn.
Drafting of the article: H.B. El-Serag.
Critical revision of the article for important intellectual content: H.B. El-Serag, J.A. Davila, K.A. McGlynn.
Final approval of the article: H.B. El-Serag, J.A. Davila, N.J. Petersen, K.A. McGlynn.
Statistical expertise: H.B. El-Serag, N.J. Petersen.
Administrative, technical, or logistic support: H.B. El-Serag.
The incidence of hepatocellular carcinoma was reported to be increasing in the United States. However, alternate explanations were diagnostic or reclassification bias and changes in the demographic features of the general population.
To examine the temporal trends in the incidence of hepatocellular carcinoma.
Retrospective cohort study.
Information collected by population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program.
Persons given a diagnosis of hepatocellular carcinoma between 1975 and 1998.
Linear Poisson multivariate regression model, controlling for differences in age, sex, race or ethnicity, and geographic region among patients with hepatocellular carcinoma and in the underlying population.
The overall age-adjusted incidence rates of hepatocellular carcinoma increased from 1.4 per 100 000 in 1975 to 1977 to 3.0 per 100 000 in 1996 to 1998. There was a 25% increase during the last 3 years of the study compared with the preceding 3 years (1993 to 1995). The increase affected most age groups above 40 years, with the greatest increase in the 45- to 49-year-old age group. White men had the greatest increase (31%) in the last time period (1996 to 1998) compared with 1993 to 1995. The Poisson regression model confirmed an almost 2-fold increase in the incidence rate ratio for hepatocellular carcinoma between 1975 to 1978 and 1996 to 1998.
The incidence of hepatocellular carcinoma continues to increase rapidly in the United States, with rates increasing the fastest in white men 45 to 54 years of age. These findings are consistent with a true increase and could be explained by consequences of hepatitis C virus acquired during the 1960s and 1970s.
Incidence rates of hepatocellular carcinoma have been increasing in the United States.
This large, retrospective, population-based cohort study confirmed an almost 2-fold increase in the incidence of hepatocellular carcinoma from 1975 to 1998. Increases were seen in all ethnic groups and in most age groups after 40 years of age. Although black people and older people remained most at risk, the largest recent increase in rates (from 1995 to 1998) occurred in white men 45 to 54 years of age.
The incidence of hepatocellular carcinoma continues to increase rapidly in the United States, especially in white, middle-aged men.
The overall age-adjusted incidence rates for hepatocellular carcinoma for consecutive 3-year periods between 1975 and 1998.
Age-adjusted incidence rates for hepatocellular carcinoma broken down by sex and race or ethnicity for consecutive 3-year periods between 1975 and 1998.
Temporal trends in the age distribution of hepatocellular carcinoma.
Temporal trends in age-specific incidence rates for white men 45 to 49 years of age and 50 to 54 years of age.
Table 1. Results of Multivariate Analysis Using Hierarchical Poisson Regression To Examine the Association between the Incidence of Hepatocellular Carcinoma and Time of Diagnosis, Age, Race or Ethnicity, Sex, and Geographic Region
Table 2. Take-home points
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El-Serag HB, Davila JA, Petersen NJ, et al. The Continuing Increase in the Incidence of Hepatocellular Carcinoma in the United States: An Update. Ann Intern Med. 2003;139:817–823. doi: 10.7326/0003-4819-139-10-200311180-00009
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Published: Ann Intern Med. 2003;139(10):817-823.
Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Liver Cancer, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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