In 1991, American cancer deaths peaked at 215 per 100,000 people, roughly 1 in 4 of all deaths. Then they started to fall, and by 2022 they had dropped 34%, an estimated 4.5 million fewer deaths. The national figure hides a split.
Arthur Cosby, a sociologist at Mississippi State University, and colleague Viswadeep Lebakula went looking for it. Writing in The Conversation, Cosby said his team tracked cancer death rates in almost 3,000 U.S. counties from 1981 through 2019. Where people lived, they found, shaped their odds of surviving.
Coasts pulled ahead
Big urban centers on both coasts improved fastest. Death rates in the four largest boroughs of New York City fell more than 40% between 1991 and 2019, and Manhattan led with 47% fewer deaths. Around San Francisco Bay, Marin County recorded a 47% decline, San Mateo County 44% and San Francisco County 40%, all well past the 34% national figure. The Boston to Washington, D.C., corridor also saw steep declines.
The nation’s interior improved least.
Left behind
Before 1991, rural and urban America had roughly the same cancer death rates. Once the national rate began falling, rural and small-town counties lagged. Nonmetropolitan declines were modest: 29% in Montana, 24% in West Virginia, 23% in Arkansas and 20% in Mississippi. About 458 rural counties saw cancer mortality go up.
Money mattered as well. When deaths peaked in 1991, counties at the top and bottom of the income scale looked similar. By 2019, the 10% of Americans living in the highest-income counties had seen gains roughly seven times those of the 10% in the poorest counties.
Tobacco explains part of it. Lung cancer kills more people than any other cancer, and tobacco control has been a major reason its death rate has fallen. After New York City pushed aggressive tobacco measures, Manhattan recorded 60% fewer lung cancer deaths by 2019 than in 1991. Many rural and less affluent states and counties adopted fewer and weaker rules, and rural communities tend to have higher smoking rates and more exposure to smoke at home.
The same pattern in breast cancer
A separate analysis, presented at an American Association for Cancer Research meeting on health disparities, points the same way. Breast cancer mortality dropped in rural and urban populations alike between 1999 and 2020, though rural areas improved more slowly. The projection for 2035 puts the rural rate about 13% above the urban one, which works out to roughly 38 extra deaths per 1 million women. Measured per 100,000 women, the absolute gap is forecast to go from about 2 in 2020 to about 3.8 by 2035.
Income at the county level explained the biggest share of the excess rural deaths, 45.3%, and late-stage diagnosis came next at 24.9%. “Although breast cancer mortality has declined overall in the United States, our findings underscore that this progress has not been shared equally between rural and urban communities,” said Nickolas Stabellini of Case Western Reserve University. The study is observational and cannot establish causation.
Cosby’s own prescription was tobacco policies and screening tailored to rural settings, plus wider access to advanced treatment in rural and poor places.
Sources
- Rural areas lag behind in cancer treatment and prevention (The Conversation)
- Rural-Urban Breast Cancer Mortality Gap Projected to Widen in Next Decade (Targeted Oncology)
