Temporal trends in liver cancer mortality by educational attainment in the United States, 2000-2015

Background Liver cancer is the most rapidly rising cause of cancer death in the United States. However, it is unclear whether the mortality trend differs by socioeconomic and/or hepatitis C virus (HCV) infection status. Methods Joinpoint analyses and Poisson regression modeling were performed to examine trends in death rates from liver cancer by education and HCV infection status among persons aged 25 to 74 years from 2000 to 2015. Disparities in liver cancer mortality were measured as a relative index of inequality by education. Results From 2000 to 2015, the overall liver cancer death rate (per 100,000 persons) increased from 7.5 to 11.2 in men and from 2.8 to 3.8 in women. The increase was generally steeper in less educated groups for women and was confined to persons with <= 15 years of education for men. Consequently, the relative disparity increased until 2006 and then levelled off in women, whereas it continued to increase from 3.49 (95% CI, 3.08-3.97) to 7.74 (95% CI, 7.13-8.40) in men, with the increase more pronounced for HCV-related liver cancer than HCV-unrelated liver cancer. Conclusions The increases in liver cancer death rates in the United States have largely been confined to less educated persons, especially among men. Enhanced and targeted efforts are needed to halt and reverse the undue growing burden of liver cancer in lower socioeconomic groups.