Patients with hepatocellular carcinoma from more rural and lower‐income households have more advanced tumor stage at diagnosis and significantly higher mortality

Background Patients from rural and low‐income households may have suboptimal access to liver disease care, which may translate into worse HCC outcomes. The authors provide a comprehensive update of HCC incidence and outcomes among US adults, focusing on the effect of rural geography and household income on tumor stage and mortality. Methods The authors retrospectively evaluated adults with HCC using Surveillance, Epidemiology, and End Results data from 2004 to 2017. HCC incidence was reported per 100,000 persons and was compared using z‐statistics. Tumor stage at diagnosis used the Surveillance, Epidemiology, and End Results staging system and was evaluated with multivariate logistic regression. HCC mortality was evaluated using Kaplan‐Meier and multivariate Cox proportional hazards methods. Results HCC incidence plateaued for most groups, with the exception of American Indians/Alaska Natives (2004‐2017: APC, 4.17%; P < .05) and patients in the lowest household income category (1 million, patients in more rural regions had higher odds of advanced‐stage HCC at diagnosis (odds ratio, 1.10; 95% CI, 1.00‐1.20; P = .04) and higher mortality (hazard ratio, 1.05; 95% CI, 1.01‐1.08; P = .02). Compared with the highest income group (≥$70,000), patients with HCC who earned