Background: Liver cancer (LC) incidence has tripled over the past four decades, with hepatocellular carcinoma (HCC) being the most common type (72%). Further, LC mortality often coincides with incidence, as the disease is often fatal. To illustrate, the five-year survival rate (2012-2018) for LC is 21% at all stages, compared to lung cancer at 23% and colon cancer at 65%. While incidence and death rates of LC have stabilized in the past 5 years, troubling disparities have been identified when rates are stratified by region, age, race, and ethnicity. For example, HCC incidence in rural areas has increased by 5.7% annually, with rates approaching that of urban ones, despite a historically lower incidence. Consequently, as several inequalities in HCC have been established, the study herein aims to identify whether recognition of these disparities has helped to reduce their growth. Methods: We identified incidence rates of HCC from the Surveillance, Epidemiology and End Results Program database at 4-year time intervals from 2000-2019, stratified by age above (>) and below (<) 60, metropolitan (M) vs nonmetropolitan (NM) counties, race, and ethnicity. Next, we calculated percent change and percent difference in HCC rates across time intervals and groups to evaluate trends. Results: Percent change in rates of HCC has increased since 2000 in those >60 in both M and NM areas with larger growth observed in NM counties. Conversely, between 2010 and 2019 HCC rates have declined in those <60, with a steeper decline observed in M (-18.2%) vs NM (-10.0%) counties. Alarmingly, when 2015-2019 HCC rates are stratified by race/ethnicity, each minority group studied exhibited considerably higher rates of HCC when compared to whites and non-Latinos of the same age group and region (percent difference = >60 M; >60 NM; <60 M; <60 NM): Black (50.3%; 37.2%; 24.1%; 26.6%), American Indian (21.2%; 85.8%; 7.6%; 77.5%), Asian (17.3%; 17.8%; 21.1%; 28.1%), and Latino (39.0%; 45.6%; 40.0%; 36.1%). [Reference: white rates = 35.4; 31.7; 5.1; 4.9 and non-Latino rates = 36.5; 33; 2.4; 2.5, respectively, per 100,000 and age adjusted to the 2000 US Standard Population]. Conclusions: Recent data describes a stabilization in LC incidence and death rates over the past 5 years. However, when HCC incidence is stratified by age, region, race, and ethnicity, disconcerting trends continue to be revealed. As such, interventions should be targeted at those >60, living in NM areas, and in the minority groups studied to combat these disparities.