Rural-Urban Cancer Incidence and Trends in the United States, 2000-2019.

Abstract

Background Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural-urban differences in cancer incidence and trends. Methods We used the North American Association of Central Cancer Registries (NAACCR) dataset to investigate rural-urban differences in 5-year age-adjusted cancer incidence (2015-2019) and trends (2000-2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEER*Stat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APCs). Results We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared to urban a (447.9), with the largest rural-urban difference in the South (464.4 vs 449.3). Rural populations also exhibited higher rates of tobacco-associated, HPV-associated, and colorectal cancer, including early-onset. Tobacco-associated cancer incidence trends widened between rural and urban from 2000-2019, with significant, but varying, decreases in urban areas throughout the study period, while significant rural decreases only occurred between 2016 and 2019 (APC=-0.96). HPV-associated cancer rates increased in both populations until recently with urban rates plateauing while rural rates continued to rise (e.g., APC =1.56, 2002-2019). Conclusions Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared to urban. Improvements in these rates were typically slower in rural populations. Impact Our findings underscore the complex nature of rural-urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.