U.S. death rates from liver cancer have risen steadily since 2000, resulting in the disease going from the ninth-leading cause of cancer death to the sixth, a new report finds. 
 
 The change comes as U.S. cancer death rates overall — meaning rates for all combined cancers — have declined since 1990, according to the report, published today (July 17) by the Centers for Disease Control and Prevention. 
 
 But from 2000 to 2016, liver cancer death rates in adults ages 25 and up rose 43 percent, from 7.2 deaths per 100,000 people in 2000 to 10.3 deaths per 100,000 people in 2016, the report found. The rates increased for both men and women; however, the death rates for men were 2 to 2.5 times higher than the rates for women throughout the study period. [10 Do's and Don'ts to Reduce Your Risk of Cancer] 
 
 Death rates for other cancers — such as lung, colon and breast cancers — have fallen thanks to lower rates of people getting these cancers, as well as better ways to detect and treat these cancers, said Dr. Jeffrey Drebin, chair of the Department of Surgery at Memorial Sloan Kettering Cancer Center in New York City and a liver cancer surgeon. Drebin was not involved with the new report. 
 
 Liver cancer, however, hasn't seen similar improvements, Drebin told Live Science. For example, the rates of people getting liver cancer haven't changed much, and the disease is still difficult to detect and, in many cases, treat. 
 
 Drebin noted that although the rates of liver cancer due to some causes — such as hepatitis B, a viral infection that causes inflammation of the liver — have decreased, the rates of the disease due to other causes — including obesity-related cirrhosis, or scarring of the liver — have gone up. Therefore, the rates of people getting liver cancer due to different causes are "probably balanced out," he said. 
 
 What's more, even though new drugs are available to treat hepatitis C, another viral infection that causes liver inflammation, these drugs "may not prevent the eventual development of liver cancer," Drebin said. 
 
 Liver cancer death rates were the highest in adults ages 75 and up during the entire study period, the report found. Death rates rose for adults in this age group during the study period, as well as for adults ages 65 to 74 and adults ages 55 to 64. Adults ages 45 to 54 saw an increase in death rates from 2000 to 2005, followed by a decrease in rates from 2012 to 2016. Liver cancer death rates for adults ages 25 to 44 did not change during the study period. 
 
 Drebin noted that liver cancer rates rise with age because of the long-term effects of liver inflammation. (In other words, the longer a person has inflammation of the liver, the more likely that person is to develop liver cancer.) 
 
 Looking at death rates by race and ethnicity, the report found that death rates rose in Hispanic, non-Hispanic black and non-Hispanic white adults from 2000 to 2016. Liver cancer death rates fell for one group during the study period: non-Hispanic Asian or Pacific Islander. This group, however, had the highest liver cancer death rate of all the groups in 2000. 
 
 The report also found that, after adjusting for age, liver cancer death rates in 2016 were the highest in Washington, D.C. (16.8 deaths per 100,000 people) and the lowest in Vermont (6 deaths per 100,000 people). 
 
 The report is based on data from the National Vital Statistics System, a database that contains death certificates from all 50 states and the District of Columbia. 
 
 Originally published on Live Science. 

 NCHS Data Brief No. 314, July 2018 
 
 PDF Version (661 KB) 
 
 Jiaquan Xu, M.D. 
 
 Key findings 
 
 Data from the National Vital Statistics System, Mortality 
 
 Age-adjusted death rates for liver cancer increased 43%, from 10.5 per 100,000 U.S. standard population to 15.0 for men and 40%, from 4.5 to 6.3 for women, between 2000 and 2016. 
 
 During 2000–2016 , liver cancer death rates decreased 22% for non-Hispanic Asian or Pacific Islander (API) adults, but increased 48% for non-Hispanic white, 43% for non-Hispanic black, and 27% for Hispanic adults. 
 
 , liver cancer death rates decreased 22% for non-Hispanic Asian or Pacific Islander (API) adults, but increased 48% for non-Hispanic white, 43% for non-Hispanic black, and 27% for Hispanic adults. Trends in liver cancer death rates varied by age group, but increasing trends from 2000 through 2016 were observed for adults aged 65–74 and 75 and over. 
 
 and 75 and over. In 2016, among the 50 states and the District of Columbia (D.C.), D.C. had the highest death rate while Vermont had the lowest. 
 
 Liver cancer (including intrahepatic bile duct cancer) was the ninth leading cause of cancer death in 2000 and rose to sixth in 2016 (1). Although death rates for all cancer combined have declined since 1990, a recent report documented an increasing trend in liver cancer death rates during 1990–2014 (2,3). In this report, trends in liver cancer death rates are examined by sex, race and Hispanic origin, and age group from 2000 through 2016 for adults aged 25 and over. Death rates in 2016 by state and the District of Columbia (D.C.) are also presented. 
 
 Keywords: sex, intrahepatic bile duct, race and ethnicity, National Vital Statistics System 
 
 Age-adjusted liver cancer death rates increased steadily from 2000 through 2016 for both men and women aged 25 and over. 
 
 Liver cancer death rates for adults aged 25 and over increased 43% from 7.2 per 100,000 U.S. standard population in 2000 to 10.3 in 2016 Figure 1) 
 
 Liver cancer death rates increased 43% from 10.5 in 2000 to 15.0 in 2016 for men and 40% from 4.5 to 6.3 for women. 
 
 The death rate for men was between 2.0–2.5 times the rate for women throughout the period. 
 
 Figure 1. Age-adjusted death rates for liver cancer among adults aged 25 and over, by sex: United States, 2000–2016 
 
 1Significant increasing trend from 2000 to 2016 (p < 0.05). 
 
 2Significantly higher than women throughout the period (p < 0.05). 
 
 NOTES: Liver cancer deaths are identified with International Classification of Diseases, 10th Revision, using underlying cause-of-death code C22. Access data table for Figure 1. 
 
 SOURCE: NCHS, National Vital Statistics System, Mortality. 
 
 Age-adjusted death rates for liver cancer increased during 2000–2016 for non-Hispanic white, non-Hispanic black, and Hispanic adults but decreased for non-Hispanic Asian or Pacific Islander adults. 
 
 During 2000–2016 , the age-adjusted death rate for liver cancer increased 48% (6.1 per 100,000 U.S. standard population to 9.0) for non-Hispanic white adults and 43% (9.5 to 13.6) for non-Hispanic black adults Figure 2) 
 
 , the age-adjusted death rate for liver cancer increased 48% (6.1 per 100,000 U.S. standard population to 9.0) for non-Hispanic white adults and 43% (9.5 to 13.6) for non-Hispanic black adults While non-Hispanic Asian or Pacific Islander (API) adults had the highest liver cancer death rates during 2000–2014 among the four race and Hispanic-origin groups, this group experienced the only decrease (22%), from 17.5 in 2000 to 13.6 in 2016. 
 
 The liver cancer death rate increased 27% from 11.5 in 2000 to 14.6 in 2016 for Hispanic adults, surpassing the rate for non-Hispanic API adults in 2016. 
 
 Non-Hispanic white adults had the lowest death rate among the four racial and ethnic groups throughout the period. 
 
 Figure 2. Age-adjusted death rates for liver cancer among adults aged 25 and over, by race and ethnicity: United States, 2000–2016 
 
 1Significant decreasing trend for non-Hispanic Asian or Pacific Islander adults from 2000 to 2016 (p < 0.05). 
 
 2Significantly higher compared with non-Hispanic white adults throughout the period (p < 0.05). 
 
 3Significant increasing trend from 2000 to 2016 (p < 0.05). 
 
 NOTES: Liver cancer deaths are identified with International Classification of Diseases, 10th Revision, using underlying cause-of-death code C22. Access data table for Figure 2. 
 
 SOURCE: NCHS, National Vital Statistics System, Mortality. 
 
 Death rates for liver cancer increased from 2000 through 2016 for age groups 65–74 and 75 and over. 
 
 For adults aged 25–44 , the rate remained essentially unchanged during 2000–2016 Figure 3) 
 
 , the rate remained essentially unchanged during For adults aged 45–54 , the rate increased 31% from 2000 to 2005, remained stable from 2005 to 2012, and then decreased 20%, from 5.5 per 100,000 population in 2012 to 4.4 in 2016. 
 
 , the rate increased 31% from 2000 to 2005, remained stable from 2005 to 2012, and then decreased 20%, from 5.5 per 100,000 population in 2012 to 4.4 in 2016. For adults aged 55–64 , the rate increased 109% from 9.3 in 2000 to 19.4 in 2013, but remained stable through 2016. 
 
 , the rate increased 109% from 9.3 in 2000 to 19.4 in 2013, but remained stable through 2016. For adults aged 65–74 , the rate increased 7%, from 18.7 in 2000 to 20.0 in 2008, and 37% from 20.0 in 2008 to 27.3 in 2016. The rate increased 35% (29.8 in 2000 to 40.2 in 2016) for adults aged 75 and over. 
 
 , the rate increased 7%, from 18.7 in 2000 to 20.0 in 2008, and 37% from 20.0 in 2008 to 27.3 in 2016. The rate increased 35% (29.8 in 2000 to 40.2 in 2016) for adults aged 75 and over. The liver cancer death rate was the highest for adults aged 75 and over, followed by age groups 65–74 , 55–64 , 45–54 , and 25–44 . 
 
 Figure 3. Death rates for liver cancer among adults aged 25 and over, by selected age groups: United States, 2000–2016 
 
 1Significant increasing trend from 2000 to 2016 (p < 0.05). 
 
 2Significant differences across all age groups throughout the period (p < 0.05). 
 
 3Significant increasing trend from 2000 to 2013 (p < 0.05), and stable trend from 2013 to 2016. 
 
 4Significant increasing trend from 2000 to 2005 (p < 0.05), stable trend from 2005 to 2012, and decreasing trend from 2012 to 2016 (p < 0.05). 
 
 NOTES: Rates are plotted on a logarithmic scale. Liver cancer deaths are identified with International Classification of Diseases, 10th Revision, using underlying cause-of-death code C22. Access data table for Figure 3. 
 
 SOURCE: NCHS, National Vital Statistics System, Mortality. 
 
 In 2016, the District of Columbia had the highest age-adjusted liver cancer death rate and Vermont had the lowest rate. 
 
 In 2016, age-adjusted death rates for liver cancer among adults were highest in D.C. (16.8 per 100,000 U.S. standard population), Louisiana (13.8), Hawaii (12.7), and Mississippi and New Mexico (12.4 each) Figure 4) 
 
 The five states with the lowest age-adjusted liver cancer death rates were Vermont (6.0), Maine (7.4), Montana (7.7), and Utah and Nebraska (7.8 each). 
 
 Figure 4. Age-adjusted death rates for liver cancer among adults aged 25 and over, by state: United States, 2016 
 
 NOTES: Liver cancer deaths are identified with International Classification of Diseases, 10th Revision, using underlying cause-of-death code C22. Access data table for Figure 4. 
 
 SOURCE: NCHS, National Vital Statistics System, Mortality. 
 
 Summary 
 
 This report provides the most recent trends in liver cancer mortality by sex, race and Hispanic origin, and age group for adults aged 25 and over. From 2000 through 2016, death rates increased significantly for both men and women, with the death rate for men between two and two and a half times the rate for women. Liver cancer death rates increased for non-Hispanic white, non-Hispanic black, and Hispanic adults, but declined for non-Hispanic API adults. The rate for non-Hispanic white adults aged 25 and over was the lowest of the four race and Hispanic-origin groups from 2000 through 2016, while the rate for non-Hispanic API adults was the highest from 2000 through 2014. The death rate for Hispanic adults surpassed the rate for non-Hispanic API adults in 2016, thus becoming the highest among the four race and ethnicity groups. From 2000 to 2016, death rates for liver cancer increased significantly for age groups 65–74 and 75 and over. The rate for adults aged 45–54 initially increased, but then decreased significantly since 2012. Liver cancer death rates in 2016 varied by jurisdiction, with the lowest death rate in Vermont and the highest in D.C. 
 
 Definitions 
 
 Cause-of-death classification: Cause of death is determined based on medical information entered on death certificates filed in the United States. This information is classified and coded in accordance with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD–10) (4). 
 
 Underlying causes of death: Defined by the World Health Organization as “the disease or injury which initiate the train of events leading directly to death, or the circumstances of the accident or violence which produce the fatal injury” (4). In the case of liver cancer deaths, the underlying cause of death is coded to C22 according to ICD–10. 
 
 Data source and methods 
 
 All data in the report are from the 2000 to 2016 mortality files from the National Vital Statistics System. The direct standardization method was used to calculate age-adjusted death rates, using the 2000 U.S. standard population aged 25 and over and age groups with 10-year intervals (5). 
 
 More than 99% of all deaths with liver cancer reported on the death certificate were to adults 25 years of age and over and, therefore, only decedents aged 25 and over were included in this analysis. Race and Hispanic origin are reported separately on the death certificate. Persons of Hispanic origin may be of any race. A recent report has shown that, in the 1999–2011 period, deaths for the non-Hispanic API and Hispanic populations were underreported by 3% for all ages in each group (6). It was presumed that the degree of underreporting of deaths observed for the non-Hispanic API and Hispanic populations in 1999–2011 data also applied to the data for years 2012–2016. Trends in death rates were evaluated using Joinpoint Regression Program (7). A maximum of three joinpoints were allowed during the 2000–2016 period, which is the default setting. The differences between death rates were evaluated using a two-tailed z test at the 0.05 level. 
 
 About the author 
 
 Jiaquan Xu is with the National Center for Health Statistics, Division of Vital Statistics, Mortality Statistics Branch. The author gratefully acknowledges the assistance of Sally C. Curtin, who provided the content review. 
 
 References 
 
 Suggested citation 
 
 Xu JQ. Trends in liver cancer mortality among adults aged 25 and over in the United States, 2000–2016. NCHS Data Brief, no 314. Hyattsville, MD: National Center for Health Statistics. 2018. 
 
 Copyright information 
 
 All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. 
 
 National Center for Health Statistics 
 
 Charles J. Rothwell, M.S., M.B.A., Director 
 
 Jennifer H. Madans, Ph.D., Associate Director for Science 
 
 Division of Vital Statistics 
 
 Delton Atkinson, M.P.H., M.P.H., P.M.P., Director 
 
 Hanyu Ni, Ph.D., M.P.H., Associate Director for Science 
 
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– Mortality for all cancers combined has gone down for US adults—but between 2000 and 2016, death rates from liver cancer went up 43%, according to a new CDC report. The cancer itself isn't getting any deadlier—the increase in mortality rates is due to more people developing the disease, CNN reports. Liver cancer is caused by underlying liver disease more than 70% of the time, and factors including obesity, smoking, and excessive drinking increase one's risk for liver disease. So do hepatitis B and C infections, and one cancer researcher believes the prevalence of hepatitis C in the baby boomer community, as well as a rise in excess body weight, is behind the increase in people dying from liver cancer. As the author of the report explains, blood transfusions and organ transplants were not screened for hepatitis C until 1992, and it often takes years for someone infected with hepatitis C to develop liver cancer. So it makes sense that older people who got blood transfusions or an organ transplant prior to 1992 are now experiencing more cases of liver cancer; mortality was greatest in those 75 or older. But the opioid epidemic could also be contributing, according to one oncologist, since hepatitis C can be spread by sharing needles. Liver cancer is now the sixth-leading cause of cancer death, up from the ninth, LiveScience reports.