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

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. 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. 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. 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.