title: Mortality from hepatocellular and biliary cancers: changing epidemiological trends.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma may be rising in the United States. The aim of this study was to determine the epidemiological trends in mortality from hepatocellular carcinoma (HCC) and biliary cancers (BCs) in Maryland during the last 3 decades.
  
  
  METHODS
  The number of deaths due to HCC and BCs from 1970 to 1997 were obtained from the Maryland State Department of Health & Hygiene vital statistics database. Malignant neoplasms of the gallbladder and intrahepatic and extrahepatic bile ducts were grouped together as biliary cancers. To determine the trend in mortality, the total time period was divided into seven 4-yr periods.
  
  
  RESULTS
  Mortality from HCC increased from 0.94 to 1.84 per 100,000 population (rate ratio = 1.94, CI = 1.87-2.03) and that from BCs increased from 1.28 to 1.7 per 100,000 population (rate ratio = 1.31, CI = 1.26-1.36) over the study period. Although mortality due to HCC doubled in men (1.34 to 2.7 per 100,000) during this period, only a modest increase was observed among women (0.59 to 1.06 per 100,000). Because of a marked increase in the number of deaths among white Americans, the difference in HCC-related mortality between white Americans and African Americans decreased considerably during this period. Mean age at death increased steadily for BCs from 67 to 73 yr, whereas there was no real trend for HCC. Among African Americans, the death from HCC remained stable, but there was a 2-fold increase in BC-related death.
  
  
  CONCLUSIONS
  There was a marked increase in deaths from HCC over the past 3 decades in Maryland. This increase was more evident among men and white Americans. Deaths due to BCs increased modestly during the same period of observation. The marked rise in BC-related deaths among African Americans remains unexplained.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Satheesh
authors.initials: S
authors.lastname: Nair
authors.forename: K
authors.initials: K
authors.lastname: Shiv Kumar
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Thuluvath
authors.forename: K S
authors.initials: KS
authors.lastname: Shivakumar
authors.forename: K
authors.initials: K
authors.lastname: Shiva Kumar
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000175:diagnosis / Q000401:mortality*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology