3B.02 Trends and Patterns of Disparities in Tracheal, Bronchus, and Lung Cancer Mortality Among US Counties, 1980-2014: Topic: Pulmonology

Abstract

Lung cancer is the leading cause of cancer death among men and the second leading cause of cancer death among women worldwide. Rates are highest in countries where smoking uptake began earliest, such as those in North America and Europe. Although rates are now decreasing in most of these countries, especially in men, they are increasing in countries where smoking uptake occurred later. Variation between countries may reflect different prevalence of risk factors, use of screening, and diagnostic methods. Lung cancer is the leading cause of cancer death among both men and women in the United States. Smoking is the leading cause of lung cancer incidence and mortality. In the United States, smoking rates among women peaked after those among men. The peak in smoking-related cancer mortality also occurred earlier for men than for women. The main objective is to estimate age-standardized mortality rates by US county from tracheal, bronchus, and lung cancer. Using the finding of the Global Burden of Disease (GBD) 2015 methodology which death records from the National Center for Health Statistics (NCHS) and population counts from the Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014 were used. Lung cancer cases were classified using the International Classification of Diseases for Oncology ICDO, third edition. Rates are per 100,000 population and age-adjusted by the direct method to the 2000 U.S. standard population. A total of 19 511 910 cancer deaths were recorded in the United States between 1980 and 2014, cancer mortality decreased by 20.1% [18.2%-21.4%) ], between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population. A total of 5 656 423 deaths from tracheal, bronchus, and lung (TBL) cancer were recorded. There were large differences in the mortality rate among counties throughout this period. TBL cancer mortality declined by 21.0% (95% UI, 17.9%-24.0%) between 1980 and 2014, from 68.6 (95% UI, 66.8-70.3) deaths per 100 000 population to 54.2 (95% UI, 52.7-55.6). The West and Northeast experienced declines in the mortality rate, as did Florida, while increases were observed in the South, Appalachian region, and the Midwest. The largest increase from 1980 to 2014 was observed in Owsley County, Kentucky (99.7%; 95% UI, 73.7%-130.8%), while the greatest decline was observed in Aleutians East Borough and Aleutians West Census Area, Alaska (63.6%; 95% UI, 50.3%-73.5%). High mortality rates in 2014 were clustered in Kentucky and West Virginia. Because national rates peaked in 1988, women in 2215 counties experienced a statistically significant increase in the mortality rate, while this was true for men in only 11 counties. The highest national mortality rate for men was present in 1980, while the peak in mortality rate for women was in 2001. The largest percentage increase (168.3%; 95% UI, 136.4%207.8) from 1980 to the peak in 2001 for women was observed in Marlboro County, South Carolina (mortality rate of 67.1 [95% UI, 61.4-73.5] deaths per 100 000 population in 2001). Mortality rates varied from 10.6 (95% UI, 8.6-12.8) in Summit County, Colorado, to 334.9 (95% UI, 300.5-375.2) in Union County, Florida, for males and 10.9 (95% UI, 8.3-13.8) in Summit County, Colorado, to 121 (95% UI, 101.6-142.0) in Owsley County, Kentucky, for females. Low rates were observed along the US border with Mexico and in Utah, Colorado, and parts of Arizona, New Mexico, and Idaho. From 1980 to 2014 there has been a steady decline in the cancer death rate as a result of fewer Americans smoking and advances in cancer prevention, early detection, and treatment. Local efforts to reduce smoking in poor and rural areas are needed to reduce the burden of smoking-related cancer and other diseases.