Temporal changes in sex and race/ethnicity incidence rate ratios for hepatocellular carcinoma in the United States, 1992-2022.

BACKGROUND: The incidence of hepatocellular carcinoma (HCC) has increased in the United States. Historically, HCC rates are higher among males than females and among racial and ethnic minorities compared with non-Hispanic White (NHW) individuals. However, HCC incidence patterns have changed over time. We examined how sex and race/ethnicity-specific incidence rate ratios (IRR) for HCC have evolved. METHODS: Age-adjusted HCC incidence rates were calculated using the Surveillance Epidemiology and End Results (SEER) 12 Program. Trends in sex- and race/ethnicity-specific IRRs were evaluated overall and by age group (< 50 vs. ≥50 years). IRRs were calculated as the ratio of age-adjusted rates for each comparison group to the reference group (male-to-female; racial/ethnic group-to-NHW), allowing assessment of relative disparities independent of absolute incidence. RESULTS: From 1992 to 2022, 68,023 HCC cases were identified. Incidence increased through the early 2010s before stabilizing and declining after 2015. HCC incidence remained higher among males than females; however, the male-to-female IRR declined from 3.29 to 3.11, with the most pronounced decline among adults aged <50 years. The non-Hispanic Asian/Pacific Islander (NHAPI)-to-NHW IRR declined from 5.86 to 1.87, while non-Hispanic Black (NHB)-to-NHW and Hispanic-to-NHW IRRs declined more modestly. Age-stratified analyses showed more pronounced declines in some relative disparities among younger adults, although several estimates were not statistically significant. CONCLUSIONS: Sex- and race/ethnicity-specific relative disparities in HCC incidence narrowed over three decades. These findings indicate attenuation of relative disparities, while substantial differences in absolute HCC incidence persisted across demographic groups.