The impact of alcohol consumption on the risk of hepatocellular carcinoma across different age groups: A nationwide cohort study.
BACKGROUND AND AIMS Alcohol consumption is a well-established risk factor for HCC, though its impact may vary across different age groups. Accordingly, we aimed to investigate the association between alcohol consumption and the risk of HCC across different age groups. METHODS We included 4,234,445 participants aged ≥20 years who underwent a national health examination in 2009. Cox proportional hazards regression models were used to investigate the association of alcohol consumption with the risk of HCC across age groups. RESULTS Among 3,869,084 participants, 20,475 individuals were newly diagnosed with HCC during a median follow-up of 11.3 years. When stratified by 20-year age groups, increasing alcohol consumption was significantly associated with an increased risk of HCC in the ≥60 age group compared to no alcohol consumption (P for trend <0.001). Heavy alcohol consumption was significantly associated with an increased risk of HCC in the 40-59 and ≥60 age groups, with larger effect estimates observed at older ages (aHR, 1.11; 95% CI, 1.05-1.18 for the 40-59 age group; aHR, 1.47; 95% CI, 1.38-1.57 for the ≥60 age group). CONCLUSIONS Our findings indicate that the association between alcohol consumption and the risk of HCC differs across age groups, with the most pronounced risk increase observed among older individuals. These findings may inform age-tailored HCC risk assessment and prevention strategies, particularly by identifying middle-aged and older heavy drinkers who may benefit from more careful risk stratification. IMPACT AND IMPLICATIONS Alcohol consumption is a well-established risk factor for hepatocellular carcinoma (HCC), but its age-specific impact remains insufficiently defined. In this nationwide cohort of 3,869,084 adults, heavy alcohol consumption was associated with increased HCC risk in the 40-59 and ≥60 age groups, with the strongest association and highest 10-year cumulative risk observed among heavy drinkers aged ≥60 years. These findings may help refine age-tailored HCC risk assessment by supporting the consideration of heavy alcohol consumption alongside established liver-related risk factors, particularly in middle-aged and older adults.