title: The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update.
abstract: BACKGROUND
  The incidence of hepatocellular carcinoma was reported to be increasing in the United States. However, alternate explanations were diagnostic or reclassification bias and changes in the demographic features of the general population.
  
  
  OBJECTIVE
  To examine the temporal trends in the incidence of hepatocellular carcinoma.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Information collected by population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program.
  
  
  METHODS
  Persons given a diagnosis of hepatocellular carcinoma between 1975 and 1998.
  
  
  METHODS
  Linear Poisson multivariate regression model, controlling for differences in age, sex, race or ethnicity, and geographic region among patients with hepatocellular carcinoma and in the underlying population.
  
  
  RESULTS
  The overall age-adjusted incidence rates of hepatocellular carcinoma increased from 1.4 per 100 000 in 1975 to 1977 to 3.0 per 100 000 in 1996 to 1998. There was a 25% increase during the last 3 years of the study compared with the preceding 3 years (1993 to 1995). The increase affected most age groups above 40 years, with the greatest increase in the 45- to 49-year-old age group. White men had the greatest increase (31%) in the last time period (1996 to 1998) compared with 1993 to 1995. The Poisson regression model confirmed an almost 2-fold increase in the incidence rate ratio for hepatocellular carcinoma between 1975 to 1978 and 1996 to 1998.
  
  
  CONCLUSIONS
  The incidence of hepatocellular carcinoma continues to increase rapidly in the United States, with rates increasing the fastest in white men 45 to 54 years of age. These findings are consistent with a true increase and could be explained by consequences of hepatitis C virus acquired during the 1960s and 1970s.
authors: The Houston Center for Quality of Care and Utilization Studies, Sections of Gastroenterology and Health Services Research at The Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas 77030, USA. hasheme@bcm.tmc.edu
authors: Hashem B
authors: HB
authors: El-Serag
authors: Jessica A
authors: JA
authors: Davila
authors: Nancy J
authors: NJ
authors: Petersen
authors: Katherine A
authors: KA
authors: McGlynn
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012044:Regression Analysis; D012189:Retrospective Studies; D018426:SEER Program; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology