Lancet Public Health. 2024 Mar;9(3):e186-e198. doi: 10.1016/S2468-2667(24)00002-1.
Understanding how specific populations are affected by liver cancer is important for identifying priorities, policies, and interventions to mitigate health risks and reduce disparities. This study aims to provide comprehensive analysis of rates and trends in liver cancer mortality for different racial and ethnic populations in the USA nationally and at the county level from 2000 to 2019.
We applied small-area estimation methods to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate liver cancer mortality rates by county, racial and ethnic population, and year (2000-19) in the USA. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). Estimates were adjusted using published misclassification ratios to correct for inaccuracies in race or ethnicity as recorded on death certificates, and then age-standardised. Mortality rate estimates are presented for all county and racial and ethnic population combinations with a mean annual population greater than 1000.
Nationally, the age-standardised liver cancer mortality rate increased between the years 2000 (4·2 deaths per 100 000 population [95% uncertainty interval 4·1-4·3]) and 2016 (6·0 per 100 000 [5·9-6·1]), followed by a stabilisation in rates from 2016 to 2019 (6·1 per 100 000 [6·0-6·2]). Similar trends were observed across the AIAN, Black, Latino, and White populations, whereas the Asian population showed an overall decrease across the 20-year study period. Qualitatively similar trends were observed in most counties; however, the mortality rate and the rate of change varied substantially across counties, both within and across racial and ethnic populations. For the 2016-19 period, mortality continued to increase at a substantial rate in some counties even while it stabilised nationally. Nationally, the White population had the lowest mortality rate in all years, while the racial and ethnic population with the highest rate changed from the Asian population in 2000 to the AIAN population in 2019. Racial and ethnic disparities were substantial: in 2019, mortality was highest in the AIAN population (10·5 deaths per 100 000 [9·1-12·0]), notably lower for the Asian (7·5 per 100 000 [7·1-7·9]), Black (7·6 per 100 000 [7·3-7·8]), and Latino (7·7 per 100 000 [7·5-8·0]) populations, and lowest for the White population (5·5 [5·4-5·6]). These racial and ethnic disparities in mortality were prevalent throughout the country: in 2019, mortality was higher in minoritised racial and ethnic populations than in the White population living in the same county in 408 (87·7%) of 465 counties with unmasked estimates for the AIAN population, 604 (90·6%) of 667 counties for the Asian population, 1207 (81·2%) of 1486 counties for the Black population, and 1073 (73·0%) of 1469 counties for the Latino population.
Although the plateau in liver cancer mortality rates in recent years is encouraging, mortality remains too high in many locations throughout the USA, particularly for minoritised racial and ethnic populations. Addressing population-specific risk factors and differences in access to quality health care is essential for decreasing the burden and disparities in liver cancer mortality across racial and ethnic populations and locations.
US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).
了解特定人群如何受到肝癌的影响对于确定优先事项、政策和干预措施以减轻健康风险和减少差异至关重要。本研究旨在提供美国全国范围内不同种族和族裔人群肝癌死亡率的综合分析，以及 2000 年至 2019 年县一级的死亡率趋势。
我们应用小区域估计方法，利用美国国家生命统计系统的死亡登记数据和美国国家卫生统计中心的人口数据，估计美国各县、种族和族裔人群以及年份（2000-19 年）的肝癌死亡率。种族和族裔分为非拉丁裔和非西班牙裔美洲印第安人或阿拉斯加原住民（美洲原住民）、非拉丁裔和非西班牙裔亚裔或太平洋岛民（亚裔）、非拉丁裔和非西班牙裔黑种人（黑种人）、拉丁裔或西班牙裔（拉丁裔）以及非拉丁裔和非西班牙裔白种人（白种人）。使用已发表的错误分类比率对估计值进行调整，以纠正死亡证明上种族或族裔记录的不准确之处，然后进行年龄标准化。对于平均每年人口大于 1000 的所有县和种族和族裔人群组合，都报告了死亡率估计值。
在全国范围内，2000 年（每 10 万人中有 4.2 人死亡[95%置信区间为 4.1-4.3]）至 2016 年（每 10 万人中有 6.0 人死亡[5.9-6.1]）之间，年龄标准化的肝癌死亡率呈上升趋势，之后在 2016 年至 2019 年期间稳定下来（每 10 万人中有 6.1 人死亡[6.0-6.2]）。在美洲原住民、黑种人、拉丁裔和白种人群中观察到类似的趋势，而在亚裔人群中，整个 20 年研究期间死亡率呈总体下降趋势。在大多数县也观察到定性相似的趋势；然而，死亡率和变化率在县一级以及在不同的种族和族裔人群中都有很大差异。在 2016-19 年期间，即使全国范围内稳定，一些县的死亡率仍在以相当大的速度继续上升。在所有年份，白种人死亡率最低，而种族和族裔人群中死亡率最高的人群从 2000 年的亚裔人群变为 2019 年的美洲原住民人群。种族和族裔之间存在很大的差异：2019 年，美洲原住民人群的死亡率最高（每 10 万人中有 10.5 人死亡[9.1-12.0]），而亚裔人群的死亡率明显较低（每 10 万人中有 7.5 人死亡[7.1-7.9]），黑种人（每 10 万人中有 7.6 人死亡[7.3-7.8]）和拉丁裔（每 10 万人中有 7.7 人死亡[7.5-8.0]），白种人最低（每 10 万人中有 5.5 人死亡[5.4-5.6]）。这种死亡率的种族和族裔差异在全国范围内普遍存在：在 2019 年，在与白种人生活在同一县的情况下，死亡率在 465 个县中的 408 个县（87.7%）中较高，在这些县中，非裔和西班牙裔人口的死亡率较高，在 667 个县中的 604 个县（90.6%）的亚洲人口的死亡率较高，在 1486 个县中的 1207 个县（81.2%）的黑种人口的死亡率较高，在 1469 个县中的 1073 个县（73.0%）的拉丁裔人口的死亡率较高。
尽管近年来肝癌死亡率的稳定是令人鼓舞的，但在美国许多地方，死亡率仍然过高，特别是在少数族裔和族裔人群中。解决特定人群的风险因素以及获得优质医疗保健方面的差异，对于减少肝癌死亡率在不同种族和族裔人群和地区的负担和差异至关重要。
美国国立卫生研究院（内部研究计划，国家少数民族健康和健康差异研究所；国家心脏、肺和血液研究所；内部研究计划，国家癌症研究所；国家老龄化研究所；国家关节炎和肌肉骨骼及皮肤病研究所；疾病预防办公室；和行为与社会科学研究办公室）。
