Results from a retrospective study showed that the increased rate of liver cancer death observed over the period between 2000 and 2015 was mainly restricted to individuals with fewer years of education. The findings from this study were published in Cancer.1

In the United States, deaths due to liver cancer (ie, hepatocellular carcinoma, biliary cancer) are rising more rapidly than deaths from any other cancer.2 Possible factors contributing to this increase include the high rate of hepatitis C viral (HCV) infection, as well as increasing rates of alcohol abuse, obesity, nonalcoholic fatty liver disease, and diabetes. In addition, previous studies have shown that the greatest burden of liver cancer death occurs in men, minority groups, and people of lower socioeconomic status.

This large retrospective study specifically focused on the association between HCV infection, individual-level educational attainment, and liver cancer death in the US in people aged 25 to 74 years during the period from 2000 to 2015.

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Publicly available death databases were accessed for information on the gender, age, race/ethnicity, and years of education (≤12, 13-15, or ≥16 years) of individuals with liver cancer listed as their cause of death. Data from the American Community Survey were used to estimate corresponding demographic characteristics for the overall population.

One of the key findings of this study was a 48.6% increase in the rate of liver cancer death in men between 2000 and 2015, with increases of 172.2% and 33.3% for individuals with HCV-related disease compared with non-HCV–related disease, respectively.

Furthermore, for men with HCV-related disease as a cause of death, increases of 210.3% and 39.9% were observed in those with ≤12 years compared with ≥16 years of education. While no increase was observed in the rate of non-HCV–related liver cancer death in men with ≥16 years of education (-6.3%), an increase of 55.0% was observed for those with ≤12 years of education.

Corresponding analyses for women with liver cancer as a cause of death showed a 34.7% increase in the rate of liver cancer death over the period between 2000 and 2015. As observed for men, this overall increased rate was largely driven by HCV-related liver disease, with increases of 77.4% and 31.5% for individuals with HCV-related and non-HCV–related disease, respectively. Similar to men, the increased rate of HCV-related liver cancer death in women was mainly borne by women with fewer years of education (106.6% [≤12 years] and 11.1% [≥16 years]). However, for those with non-HCV–related liver disease as a cause of death, similar increases in rates of liver cancer death were observed for women with ≤12 years (41.0%) compared with ≥16 years (33.0%) of education.

Of note, although the increased rate in liver cancer death observed from 2000 and 2015 was largely driven by increases in HCV-related liver cancer death, more individuals died of non-HCV–related liver cancer. Specifically, in 2015, 2731 and 10,281 men died of HCV-and non-HCV–related liver cancer. Similarly, in that year, HCV-related liver cancer and non-HCV–related liver cancer were the causes of death in 459 and 4249 women, respectively.

“These findings underscore the need for enhanced and targeted efforts in promoting bodyweight control and diabetes prevention, reducing excessive alcohol consumption, and improving HCV testing and treatment of HCV infections and early liver disease to reverse the increasing trends in liver cancer mortality and the widening socioeconomic disparities in the country,” the authors noted in conclusion.1


  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.  doi: 10.1002/cncr.32023
  2. Islami F, Miller KD, Siegel RL, Fedewa SA, Ward EM, Jemal A. Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA Cancer J Clin. 2017;67(4):273-289.