Cohort study of rural-urban disparities in hepatocellular carcinoma and mortality in the United States

A population-based cohort study examined rural-urban differences in hepatocellular carcinoma (HCC) incidence and incidence-based mortality trends by sex, race and ethnicity, and stage at diagnosis in the US from 2001 to 2022. The study analyzed 264 633 HCC cases (77.0% among men and 86.6% in urban areas. Among men, HCC incidence was 4.5 (95% CI 4.4-4.5) per 100 000 people in rural counties and 5.8 (5.8-5.8) per 100 000 in urban counties; among women, HCC incidence was 1.2 (1.2-1.2) per 100 000 in rural counties and 1.5 (1.5-1.5) per 100 000 in urban counties. Among men, incidence-based mortality rates were 2.7 (95% CI 2.3-3.0) per 100 000 in rural counties and 3.8 (3.6-3.9) per 100 000 in urban counties; among women, these rates were 0.8 (0.6-0.9) per 100 000 in rural counties and 0.9 (0.8-1.0) per 100 000 in urban counties. Both HCC incidence rates and HCC mortality rates were stable or increasing in time in rural counties and decreasing in urban counties. The trends were particularly evident among the non-Hispanic White population. The authors conclude that these findings emphasize the growing disparity between rural and urban populations in HCC incidence and mortality trends.