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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 (<$40,000; 2006‐2017: APC, 2.80%; P <.05). Compared with patients who had HCC in large metropolitan areas with a population >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 <$40,000 annually had higher odds of advanced‐stage HCC (odds ratio, 1.15; 95% CI, 1.01‐1.32; P =.03) and higher mortality (hazard ratio, 1.23; 95% CI, 1.16‐1.31; P <.001). Conclusions: Patients from rural regions and lower‐income households had more advanced tumor stage at diagnosis and significantly higher HCC mortality. These disparities likely reflect suboptimal access to consistent high‐quality liver disease care, including HCC surveillance. Patients from rural and low‐income households have suboptimal access to high‐quality liver disease care, which affects timely receipt of surveillance for hepatocellular carcinoma (HCC). This study of a large national cancer registry demonstrates that patients from rural regions and low‐income households have more advanced HCC tumor stage at diagnosis and overall lower HCC survival. [ABSTRACT FROM AUTHOR]