HCC Incidence Higher in Rural Populations Due to Changing Risk Factors and Access Barriers
Key Takeaways:
- The hepatocellular carcinoma (HCC) incidence rate is higher among men in rural areas than any other population. From 2001 to 2022, HCC incidence rates among men were 4.5 per 100 000 people in rural areas and 5.8 per 100 000 people in urban areas. For women, the rate was 1.2 per 100 000 people in rural areas and 1.5 per 100 000 people in urban areas.
- HCC incidence has increased by 1.1% annually among men in rural areas and by 1.7% annually among women. HCC incidence has decreased by 1.4% annually among men in urban areas and by 1% among women.
- The HCC incidence-based mortality rate has increased by 1.2% per year for men in rural areas and decreased by 1.4% per year for men in urban areas. Women in rural areas have not experienced a change in mortality while the mortality rate has decreased by 1% per year among women in urban areas.
While recent studies document a national decrease in HCC incidence, it is unknown if these trends are distributed uniformly across the US. Improvements in viral hepatitis prevention and treatment have contributed to the decrease of HCC, but alcohol-related liver disease (ALD), obesity, diabetes, and metabolic dysfunction–associated steatohepatitis (MASH) have emerged as new risk factors for HCC. These risk factors are more common in rural populations, so investigators sought to determine if there were any rural-urban disparities in HCC incidence and incidence-based mortality.
The study analyzed data from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) databases. Researchers examined HCC diagnoses from 2001 to 2022 and used data from SEER-21 to evaluate incidence-based mortality.
HCC Incidence Differences Among Geographic Region and Sex
The study evaluated 264 633 HCC cases; 86.6% occurred in urban locations and 13.4% occurred in rural areas. HCC incidence was also more common among men: 77% of cases were among men and 23% were among women.
From 2001 to 2022, HCC incidence rates among men were 4.5 per 100 000 people in rural areas and 5.8 per 100 000 people in urban areas. For women, the rate was 1.2 per 100 000 people in rural areas and 1.5 per 100 000 people in urban areas, significantly less than men regardless of geographic location.
Among men in rural locations, HCC incidence increased by 7.3% per year from 2001 to 2007 and then increased by 1.1% per year from 2007 to 2022. Men in urban areas experienced a 4% annual increase in HCC diagnosis from 2001 to 2007 but have since had a 1.4% annual decrease from 2007 to 2022.
Among women in rural locations, HCC incidence increased each year by 1.7% from 2001 to 2022, a significantly smaller rise than men from the same geographic area. In urban areas, HCC incidence increased among women by 3.1% per year from 2001 to 2009 and then decreased by 1% per year from 2009 to 2022.
Disparities HCC Incidence-Based Mortality
From 2007 to 2022, HCC incidence-based mortality rates among men were 2.7 per 100 000 people in rural areas and 3.8 per 100 000 people in urban areas. For women during this time period, the mortality rate was 0.8 per 100 000 people in rural areas and 0.9 per 100 000 people in urban areas, once again much lower among women from either geographic region.
Despite the incidence-based mortality rate being higher among men from urban areas, this group experienced a decrease by 1.4% per year while the morality rate increased by 1.2% per year for men in rural areas. Among women, the incidence-based mortality rate remained stable in rural areas and decreased by 1% annually in urban areas.
Implications for Prevention and Treatment
While HCC diagnoses have decreased nationwide, this study shows that this trend primarily applies to urban populations. Rural areas, on the other hand, have experienced an increase in HCC incidence rates.
The reason for this disparity is largely due to new risk factors for HCC (MASH, ALD, obesity, and diabetes) that affect rural locations more than urban areas. Men are more likely to be exposed to these risk factors, which could also explain why HCC is more common in men than women.
The study’s authors also note that “residents of rural areas face significant barriers to accessing both preventive and specialized care, such as a lack of hepatologists, longer travel distances to tertiary centers, and lower screening rates for cirrhosis and HCC.” These barriers impede timely diagnosis and treatment for people with HCC.
The study’s findings suggest that prevention and treatment for HCC have not been proportionately distributed across geographic regions. The authors recommend expanding access to specialized care for people in rural areas as well as implementing targeted strategies to improve prevention and early diagnosis.
Reference
Damgacioglu H, Uygun G, Deshmukh AA, Kaseb AO, Noonan AM, Demir T. Rural-urban disparities in hepatocellular carcinoma incidence and mortality. Jama Netw Open. 2026;9(5):e2612323. doi:10.1001/jamanetworkopen.2026.12323
