In the U.S, the incidence and mortality rates of hepatocellular carcinoma (HCC) commenced to decrease for most groups in 2015, however, persistent differences in rates continued to be present. No significant decrease occurred in the rates among non-Hispanic Black individuals, and rates among American Indians/Alaska Natives significantly rose, indicating the need for greater effort to attenuate HCC burden among these vulnerable populations.

• Data from the Surveillance, Epidemiology, and End Results program were used to estimate age-standardized rates of HCC incidence and mortality by race/ethnicity, gender and age between 1992-2018.

• A significant decline in HCC incidence occurred between 2015-2018 (APC [annual percent change], -5.6%).

• Incidence declines were evident in most groups, but the trends were most evident among Asians/Pacific Islanders, women and persons aged <50 years.

• Exceptions were the rates among non-Hispanic Black individuals, which did not significantly decrease (APC, -0.7), and among American Indians/Alaska Natives, which significantly rose (APC, +4.3%).

• By age-period-cohort modelling, birth-cohort had a greater impact on rates than calendar period.

• The highest rates were seen in the 1950-1954 cohort among the baby-boom cohorts.

• Death rates attributable to HCC decreased between 2013-2018 (APC, -2.2%), similar to the overall incidence decline.