Rural America's High Cancer Mortality Rates Point to Growing Disparities

A recent analysis of cancer incidence and mortality rates across America finds that while those in rural counties are less likely to get cancer, tcancer-related mortality rates are higher than in more populous areas, and this disparity is increasing over time.

The surveillance study, conducted by CDC researchers, was published in the Morbidity and Mortality Weekly Report. It used data from several national registries to calculate average annual age-adjusted incidence and death rates in 4 types of counties:

• Nonmetropolitan rural
• Nonmetropolitan urban
• Metropolitan with population <1 million
• Metropolitan with population ≥1 million

It also compared the trends in these rates in recent years among counties classified as nonmetropolitan or metropolitan.

From 2004 to 2013, the incidence rate of cancers at all sites was lower in rural counties than in the other county types, but rural residents had higher rates of developing lung, colorectal, and cervical cancers. Overall incidence rates in nonmetropolitan counties decreased by about 0.8% per year during this period, while they decreased in metropolitan counties by 1% annually.

Cancer death rates were higher in nonmetropolitan rural counties than the others during 2011 to 2015. While cancer mortality decreased nationwide from 2006 to 2015, death rates showed a steeper decline in metropolitan counties (1.6% decrease per year) than in nonmetropolitan counties (1.0% decrease per year).

To explain the findings, the researchers referenced prior studies showing that rural residents are more likely to have risk factors for cancer, such as cigarette smoking or obesity, and may have more difficulty accessing screening due to higher uninsurance rates.

“While geography alone can’t predict your risk of cancer, it can impact prevention, diagnosis and treatment opportunities — and that’s a significant public health problem in the U.S.,” said Anne Schuchat, MD, acting director of the CDC, in a press release. “Many cancer cases and deaths are preventable and with targeted public health efforts and interventions, we can close the growing cancer gap between rural and urban Americans.”

According to the study, these interventions will need to use “evidence-based strategies to improve health-related behaviors, use of vaccinations that prevent infections with cancer-causing viruses, and use of cancer screening tests” among rural residents in particular.

A blog post by Robert T. Croyle, PhD, of the National Cancer Institute (NCI), explored the potential next steps toward reducing cancer disparities in light of both the CDC study and a recent NCI commentary that discussed the issue. He called for stronger outreach to rural community organizations and for a better understanding of the racial demographics in rural areas. Croyle also noted that the NCI will host a meeting in May 2018 to collaborate with researchers on potential solutions to reduce rural disparities.

“In the meantime, NCI will continue to work with the cancer community and others to refine and reinvigorate our cancer control efforts in rural areas across the country,” he concluded.