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Nicole Rich, Adam Yopp , Amit Singal and Caitlin Murphy UT Southwestern Medical Center

Hepatocellular Carcinoma Incidence is Decreasing Among Young and Middle- Aged Adults in the United States. Nicole Rich, Adam Yopp , Amit Singal and Caitlin Murphy UT Southwestern Medical Center Dallas, Texas. Background.

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Nicole Rich, Adam Yopp , Amit Singal and Caitlin Murphy UT Southwestern Medical Center

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  1. HepatocellularCarcinoma Incidence isDecreasingAmong Young and Middle-AgedAdults in the United States Nicole Rich, Adam Yopp, AmitSingal and Caitlin Murphy UT SouthwesternMedical Center Dallas, Texas

  2. Background • HCC incidence rates have rapidlyincreased in U.S. since 1990s but plateaued or declined in some European and Asian countries • Few studies have examined age-related differences by race/ethnicity and sex, particularly among younger and middle-aged adults (<60 y) • Competing forces: Major strides in HCV treatment with DAAs; but also aging population, increasing alcohol consumption, increase in active HCV infection, obesity and NAFLD in younger adults • Trends in risk factors differ by population subgroups (eg. age, sex, race/ethnicity) and over time

  3. Alcohol use in USA: highest increases in women, older adults and racial/ethnic minorities Grant BF et al, JAMA Psychiatry 2017

  4. NAFLD rates increasing compared to other risk factors Younossi ZM et al, Gut 2019

  5. Acute HCV infection increasing in younger adults, coinciding with opioid epidemic Liang JT et al, NEJM 2018; Zibbell JE et al, MMWR Rep 2015

  6. Aim • To examine trends in HCC incidence rates by age, sex, and race/ethnicityusing population-based data from U.S. cancer registries (SEER 13), 1992 – 2015

  7. SEER 13 Cancer Registries

  8. Methods • Age-adjusted and age-specific HCC incidence rates, overall and by 10-year age group, race/ethnicity, and sex • Race/ethnicity: non-Hispanic white, non-Hispanic black, Hispanic, and Asian/Pacific Islander • Joinpoint models to examine magnitude and direction of trends, overall and by 10-year age group, race/ethnicity, and sex • Calculated annual percent change (APC)

  9. Overall increases in HCC incidence through 2010 n = 51,188 Incidence rate 7.7 per 100,000 Rich et al, Clin Gastro Hep 2019

  10. Overall increases in HCC incidence through 2010 Rates increased annually by 4.8% from 1992-2010 Rich et al, Clin Gastro Hep 2019

  11. Plateau or slight decrease in HCC rates after 2010 Decrease of 0.7% per year (not significant) Rich et al, Clin Gastro Hep 2019

  12. In adults > 60 years, HCC incidence continued to increase Rich et al, Clin Gastro Hep 2019

  13. Higher HCC incidence rates among adults >60 of all races/ethnicities NH White NH Black Hispanic A/PI Rich et al, Clin Gastro Hep 2019

  14. In mid-2000s, HCC rates began to decrease in 40-year olds Rich et al, Clin Gastro Hep 2019

  15. In mid-2000s, HCC rates began to decrease in 40-49 year olds Decrease of 6.2% per year Rich et al, Clin Gastro Hep 2019

  16. …and in 50-year olds Rich et al, Clin Gastro Hep 2019

  17. …and in 50-year olds Decrease of 10.3% per year Rich et al, Clin Gastro Hep 2019

  18. Similar decrease in HCC incidence in younger adults of all races/ethnicities 40-49 year olds NH White NH Black Hispanic A/PI Rich et al, Clin Gastro Hep 2019

  19. Similar decrease in HCC incidence in younger adults of all races/ethnicities 40-49 year olds Decrease of 10.4% per year NH White NH Black Decrease of 6.5% per year Hispanic A/PI Rich et al, Clin Gastro Hep 2019

  20. Similar decrease in HCC incidence in younger adults of all races/ethnicities 50-59 year olds Decrease of 17.2% per year NH Black NH White A/PI Hispanic Rich et al, Clin Gastro Hep 2019

  21. Similar trends observed in younger adults of both sexes Men Women Rich et al, Clin Gastro Hep 2019

  22. Similar trends observed in younger adults of both sexes Men Women Rich et al, Clin Gastro Hep 2019

  23. Limitations • No information on liver disease etiology or other risk factors • Could not observe incidence rates after DAAs became widely available (2014) due to lag time in registry reporting • We can only observe trends but cannot attribute causality

  24. Conclusions • Overall, we may be nearing a peak in HCC incidence • HCC incidence rates continue to increase among adults >60 years, particularly racial/ethnic minorities • Clear pattern of decreasing HCC incidence rates among younger and middle-age adults (~10% per year, with even larger decreases among non-Hispanic Black patients) • Studies are needed to observe future trends • Changing demographic landscape in the US • Evolving etiology: more NAFLD and less HCV

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