Epidemiology of hepatocellular carcinoma in Canada, 1995: analysis of death certificates

A descriptive analysis of hepatocellular carcinoma (HCC) deaths in Canada for 1995 was undertaken. Cases (ICD-9 155.0) were identified from the Statistics Canada annual mortality file; age-adjusted death rates by age, sex and province were calculated. Antecedent causes and conditions leading to death listed on the death certificate, including viral hepatitis infection and cirrhosis, were examined, in addition to birthplace information. The 403 cases identified resulted in an annual age-standardized mortality rate of 2.11 deaths per 100,000 persons among men and 0.64 deaths per 100,000 persons among women. Mean age at death was 65.5 years with male-to-female ratio approximately 3:1. Compared to the age-standardized rate for birthplace of Canada of 0.96 per 100,000 (95 percent CI: 0.84, 1.10), the age-standardized mortality rates were significantly elevated for birthplace of Europe 1.72 (95 percent CI: 1.37, 2.28), Asia 5.17 (95 percent CI: 4.11, 6.44), and non-significantly elevated for all other countries 1.54 (95 percent CI: 0.94, 2.39). In total, 60 patients (15 percent) were reported to have had viral hepatitis; sufficient information was not provided for the remainder. Of the total population, 8.7 percent were reported to have had viral hepatitis B and 5.2 percent had viral hepatitis C. Information on cirrhosis was provided in 103 (26 percent) of cases. Of these, the largest proportion (45 percent) was of unknown type while 23 patients (22 percent) had alcohol-related cirrhosis. Prevalence of antecedent causes was slightly lower than reported previously and may be considered minimum estimates since inadequate information was provided in over 50 percent of deaths.