Death Rates from Liver Cancer Are Increasing, Especially in Men with Less Education

Liver cancer is the fastest growing cause of cancer death in the United States, and the increase is mainly among adults who have less education, especially men, according to a new study by the American Cancer Society (ACS).

“We found that the risk of dying from liver cancer is about twice as likely for those without a college degree compared to those with one,” said Jiemin Ma, PhD, MHS, lead study author and a senior principal scientist of surveillance research at the ACS.

Risk factors for liver cancer include drinking too much alcohol, obesity, type 2 diabetes, and non-alcoholic fatty liver disease. Another major risk factor for liver cancer is Hepatitis C (HCV) infection, which accounts for about 20 to 24% of cases each year.

Ma’s team reviewed the patients' education level and whether they had an HCV infection. Researchers analyzed data from the National Vital Statistics System of the National Center for Health Statistics and looked at liver cancer death rates in people ages 25 to 74 from 2000 to 2015.

They found death rates continued to rise during this time period. The authors said this information underscores the need for targeted efforts to reduce obesity, alcohol consumption, type 2 diabetes, and improve hepatitis C testing and treatment. The study published online April 8, 2019 in Cancer, a peer-reviewed journal of the ACS.

Education Trends in Liver Cancer Death Rates

Previous studies have shown that death rates were higher in areas where most people have limited resources.

To their knowledge, Ma and his co-authors were the first to use an individual’s education level to understand recent trends in liver cancer death rates. They sorted each person’s education history into 1 of these 3 levels:  

• up to 12 years, usually meaning a high school education
• 13 to 15 years; some education beyond high school
• 16 or more years; college degree or more

During the 15 years studied, death rates from liver cancer increased 48.6% in men and 34.7% in women. In men, the increase was only among those who did not have a college degree. In women, deaths increased across all education levels, but the rates were generally steeper for those without a college degree. 

HCV Infection Trends in Liver Cancer Death Rates

ACS researchers found that liver cancer death rates increased at a faster pace for people who had an HCV infection compared to those without one. "While anyone can get hepatitis C, 3 in 4 people with hepatitis C were born from 1945 to 1965," according to the Centers for Disease Control and Prevention. However, Ma noted that the overall increase in death rate was largely driven by HCV-unrelated liver cancers.

That means to reverse liver cancer risk, healthcare professionals need to promote bodyweight control, type 2 diabetes prevention, smoking cessation, and not drinking excessive amounts of alcohol.