title: Mortality and hospital utilization for hepatocellular carcinoma in the United States.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma (HCC) has been increasing in the United States. Although resource-intensive treatment modalities have been increasingly applied, these patients still have poor survival. We examined 2 nationally representative databases, the Multiple Cause of Death file and the Nationwide Inpatient Sample database, to examine trends in mortality and hospital service utilization related to HCC.
  
  
  METHODS
  In both databases, a priori criteria were used to identify cases of HCC. All other available diagnostic fields were examined to characterize coexistent liver disease. Age-, sex-, and race-specific mortality from HCC was calculated, and temporal changes in mortality rates were evaluated using the multivariable Poisson model. Hospital service utilization was estimated based on length of stay, total hospitalization charges, and principal procedures.
  
  
  RESULTS
  The age-, sex-, and race-specific mortality from HCC increased from 1.54 to 2.58 per 100,000 per year between 1980 and 1998. Male sex, African and Asian race, and increasing age were also associated with higher mortality. The estimated total charge for HCC hospitalizations nationwide increased from 241 million US dollars in 1988 to 509 million US dollars in 2000 after inflation adjustment. Commonly employed procedures in 2000 included angiography/embolization, resection, local ablative therapy, and liver transplantation.
  
  
  CONCLUSIONS
  In the recent past, mortality and hospital service utilization related to HCC increased substantially. Closer epidemiologic surveillance to understand causation of HCC at the population level and to help implement primary and secondary prevention is urgently warranted.
authors.affiliation: Division of Gastroenterology and Hepatology and Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. kim.ray@mayo.edu
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gores
authors.forename: Joanne T
authors.initials: JT
authors.lastname: Benson
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008113:Liver Neoplasms / Q000175:diagnosis / Q000191:economics / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology