Manhattan cut its cancer death rate by 47% between 1991 and 2019. Mississippi managed 20%.
That gap is the core finding of a county-level study described in The Conversation by a researcher who led a team of social scientists with colleague Viswadeep Lebakula. The team looked at cancer death rates in almost 3,000 U.S. counties from 1981 to 2019 and found that where people live shapes their chances of dying from the disease.
A national success with uneven gains
Cancer deaths rose for decades before peaking at 215 per 100,000 people, which meant about one in four deaths. Then the trend turned in 1991. By 2022 the rate had fallen 34%, an estimated 4.5 million fewer cancer deaths over that period.
The national figure hides sharp differences, the researchers say. Large coastal cities did best. The four biggest boroughs of New York City all saw declines of more than 40%, with Manhattan, the largest and wealthiest, leading at 47%. In the San Francisco Bay Area, Marin County recorded a 47% decline, San Mateo County 44% and San Francisco County 40%. Miami, Los Angeles, San Diego and Seattle also saw very large improvements.
Rural counties in the middle of the country fared worse. Before 1991, rural and urban America had similar cancer mortality. Once the national rate began falling, small-town and rural areas fell behind. Death rates dropped 20% in Mississippi, 23% in Arkansas, 24% in West Virginia and 29% in Montana. About 458 rural counties saw cancer mortality go up.
Income and tobacco
Money tracked the results. In 1991, counties at the top and bottom of the income scale looked much alike. By 2019, the 10% of Americans living in the highest-income counties had improvements roughly seven times greater than the 10% in the lowest-income counties.
Tobacco control is one explanation. Lung cancer is the leading cause of cancer deaths and has seen the steepest decline, helped by smoking cessation programs, health warnings, higher tobacco taxes and public-smoking bans. New York City pushed those measures early, and Manhattan had 60% fewer lung cancer deaths in 2019 than in 1991. Many rural and less affluent states and counties adopted fewer and weaker measures, and rural communities often have higher smoking rates and more tobacco smoke in the home.
The researchers suggest tobacco control and screening programs designed for rural settings, plus wider access to advanced treatment in rural and poor areas, could help more people. Consult your doctor for medical advice.
Sources
- Rural areas lag behind in cancer treatment and prevention – even as rich, urban areas increasingly leave dying from cancer in the rearview
- Rural Areas Lag in Cancer Care as Urban Areas Advance
