Geographic and etiologic heterogeneity of liver cancer in the United States: A comprehensive analysis of prevalence, mortality, DALYs, and risk factors.

Abstract

e16333 Background: Liver cancer remains a major cause of morbidity and mortality in the United States. Understanding the contribution of specific etiologies and risk factors across states is essential for targeted prevention. We used Global Burden of Disease (GBD) 2023 estimates to describe national patterns, state variation, and age and gender disparities. Methods: Age standardized prevalence, mortality, and DALY rates were obtained from the Institute for Health Metrics and Evaluation Global Burden of Disease 2023 study for all 50 states and the District of Columbia. Etiology specific burdens were assessed for hepatitis B, hepatitis C, alcohol use, NASH, and other causes. Age and gender patterns and state rankings for major metabolic and behavioral risk factors were evaluated. Results: Across etiologies, the highest burden was liver cancer due to hepatitis C (3.96 per 100,000), followed by alcohol use (3.34), hepatitis B (1.55), other causes (1.09), and NASH (1.07). Hepatitis B burden was highest in Hawaii (3.03), the District of Columbia (2.31), and Alaska (2.21) and lowest in Michigan (0.50). Hepatitis C burden was highest in Hawaii (6.98) and California (6.16) and lowest in Mississippi (2.28) and Florida (2.57). Alcohol related burden was highest in Hawaii (6.76) and lowest in Michigan (1.28). Burden due to other causes peaked in Minnesota (2.40), while NASH related burden was highest in Hawaii (1.93) and Minnesota (1.68). Prevalence was highest in males aged 80 to 84 years (121.25) and females aged 80 to 84 years (57.57). DALY rates peaked in males aged 65 to 69 years (940.62) and females aged 75 to 79 years (385.73). Gender differences were largest in Hawaii (24.96) and smallest in Michigan (4.07). No states showed reversed gender distribution. Risk factor attributable DALYs were highest for high alcohol use (48.26), followed by drug use (22.51), high BMI (19.28), tobacco (10.93), and high fasting plasma glucose (1.63). Michigan had the highest drug use attributable burden (52.76), Texas the highest alcohol related burden (39.24), West Virginia the highest BMI burden (26.79), and Arkansas the highest tobacco related burden (12.96). Conclusions: Liver cancer in the United States is driven mainly by hepatitis C and alcohol use, with substantial state level variation. Hawaii consistently shows the highest burden across etiologies, while states such as Michigan and Mississippi show lower levels. The strong influence of alcohol, drug use, and high BMI highlights the need for state specific strategies focused on addiction treatment, metabolic risk reduction, and early detection. Strengthened coordination between hepatology and public health programs is essential to reduce liver cancer burden nationwide.