Rural-urban disparities in cancer mortality in the United States from 1999 to 2019.

Abstract

6553 Background: U.S. cancer outcomes have improved in recent years, but it is unclear if these gains are realized in all geographic areas. We investigated US rural-urban disparities in age-adjusted cancer mortality rates (AAMRs) over a 20-year period. Methods: We identified cancer deaths from 1999 to 2019 in the CDC WONDER database. We classified populations into large metropolitan (≥1 million), small-or medium-sized metropolitan (50,000-999,999), and rural (<50,000) areas based on the 2013 U.S. Census classification. We calculated annual AAMRs per 100,000 individuals and stratified results by age, sex, and race/ethnicity. We estimated annual percentage changes (APC) in AAMR using robust linear regression models of the log-scale AAMR, including population size as weights, and assessed differential changes over time by geographic area with interaction tests. Results: There were 12,935,840 deaths attributed to cancer (50% large metropolitan, 31.2% medium/small metropolitan, and 18.7% rural). AAMRs were highest in rural areas with least annual improvement. AAMR in large metropolitan areas decreased from 204.5 to 142.6 (APC -1.74 (95% CI [-1.78, -1.7])), and in rural areas it decreased from 209 to 168.3 (APC -1.05 (95% CI [-1.09, -1])) (P <.001 for time trend). The absolute difference in AAMRs between large metropolitan and rural areas increased 5-fold, from 4.5 in 1999, to 25.7 in 2019. This trend was larger in elderly (>65), where rural-urban disparity grew 25-fold (P < 0.001). Non-Hispanic Blacks had higher AAMR than other racial/ethnic groups, and women had lower AAMR than men. Conclusions: In this national analysis of 20 years, rural residents suffered higher cancer mortality than their metropolitan counterparts resulting in widening disparities. Our findings inform program interventions possible through the recent reignition of the Cancer Moonshot in achieving geographic parity, and support ongoing congressional policy deliberations to increase access through re-investment in rural infrastructure.[Table: see text]