Incidence of hepatocellular carcinoma among older Americans attributable to hepatitis C and hepatitis B: 2001 through 2013

Abstract

Background In the United States, incidence and mortality rates of hepatocellular carcinoma (HCC) are increasing in older individuals. Chronic infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) are important causes of HCC; however, the contribution of viral hepatitis to recent trends in HCC incidence among older Americans is unclear. Methods Data from the Surveillance, Epidemiology, and End Results–Medicare linkage (SEER‐Medicare) for the years 2001 through 2013 were used to identify HCC cases among individuals aged ≥66 years and Medicare files were used to assess the HCV and HBV status of these HCC cases. Age‐standardized incidence rates of HCV‐attributable, HBV‐attributable, and HCV/HBV‐unrelated HCC were estimated overall and by age group, sex, and race/ethnicity. The authors also calculated annual percent changes (APCs) in HCC incidence. Results Between 2001 and 2013, a total of 15,300 HCC cases occurred in this population. Overall HCC rates increased 43% from 16.3 to 23.3 per 100,000 population (APC, 3.40% per year), whereas HCV‐attributable HCC rates nearly doubled from 4.2 to 8.2 per 100,000 population (APC, 5.62% per year). HCC rates increased more slowly for HBV‐attributable HCC (1.3 to 1.8 per 100,000 population; APC, 3.17% per year) and HCV/HBV‐unrelated HCC (11.3 to 14.1 per 100,000 population; APC, 2.35% per year). The percentage of HCC cases with evidence of HCV infection increased from 25.7% in 2001 through 2004 to 32.3% in 2011 through 2013, whereas the percentage with HBV remained stable at 8%. In 2013, higher rates for both HCV‐attributable and HBV‐attributable HCC were noted among individuals aged 66 to 75 years, men, and individuals of Asian ancestry. Conclusions Among Americans aged ≥66 years, HCC rates increased rapidly between 2001 and 2013. Although HCV‐attributable cases contributed substantially to this increase, rates of HBV‐attributable and HCV/HBV‐unrelated HCC also rose during this period.

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“…With the popularization of risk factor screening program and the application of prevention regimens, incidence of HCC has dropped significantly in many regions, such as parts of China and Japan [2]. However, an increasing trend in both incidence and mortality rates of HCC has been observed in many European countries and North America owing to the high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections [3]. In spite of the considerable number of risk factors identified for HCC, pathogenesis of this disease remains poorly understood [4,5], which is a big challenge in the development of novel therapeutic targets.…”

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“…Incidence trends over the most recent 5-year period (2011-2015) also increased among both males and females for six major racial and ethnic groups in the USA except Hispanic men and API women (both with stable trends) and API men (decreasing trends) (28). Two studies reported increasing HCC incidence across all considered racial/ethnic groups (49,50), and two others found increasing trends for all groups (52,53) except APIs, where trends were either stable (52) or decreasing (53). Age-specific HCC incidence rates also increased from 1992 to 2015 among persons 60 years and older in all racial/ethnic groups except APIs aged 70-79 years, whereas they decreased among ages 40-59 years of all races/ethnicities since the mid-2000s (51).…”

“…Patterns for age-specific trends were mixed ( Table 2). There was a suggestion of increasing trends among older adults (≥60 years) in the USA (49)(50)(51)(52)(53), whereas they decreased (53) for persons aged 35-49 years and were stable for younger age groups (53) over at least 10 years from 2000 onwards. One study reported that incidence rates had decreased among both younger (40-49 years) and middle-aged (49-53, 55, 57, 59, 61, 63) adults since around mid-2000s to 2015 (51).…”

“…Five studies from the USA and one from Canada all reported increasing short-term (48) or long-term trends until the early 2000s (54) or later (49,50,52,53). This pattern was evident among persons (48,50,52,53) and/or by sex (49, 52-54) with only one study (48) noting increasing short-term incidence for males but a stable trend among females. In addition, one study described a short-term stable trend among persons from 2010 to 2015 in the USA (51).…”

“…Many of the included studies highlighted the importance of continuing efforts to reduce the risks associated with viral hepatitis through primary (HBV vaccination) (23,25,27,48,49,60) and secondary prevention efforts. The latter include screening of high-risk populations (23,31,47,49,(51)(52)(53)61) and ensuring equitable access to curative therapies for HBV/HCV infections among all population subgroups (23,32,37,47,48,52,53,59). However, even if incidence of HCV-related HCC decreases in the future due to improved treatments and better control (75,81), this may be offset by the emerging etiological importance of NAFLD as a key risk factor (77,82).…”