Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends

Abstract

Estimates of those living in rural counties vary from 46.2–59 million, or 14–19% of the U.S. population. Rural communities face disadvantages compared to urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of five-year cancer incidence and mortality from 2009–2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus non-metropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011–2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in non-metropolitan counties (p<0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in non-metropolitan counties (p<0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011–2016 (3% of 1655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer.

Geographic and demographic features of neuroendocrine tumors in the United States of America: A population‐based study

“…[13][14][15][16][17] The sum of the total number of cases and the total population were calculated by state-county code and time period. The patient population was classified into urban and rural categories with the Rural-Urban Continuum Code (RUCC), a variable available in the SEER database.…”

Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

“…First, the main effect between urbanicity and cancer was reversed: breast cancer incidence was higher, while cervical cancer incidence was lower, in more urban versus more rural areas (Blake et al, 2017; Singh, 2011). Second, in complex mediation analysis, only SES and primary care provider density mediated the relationship between urbanicity and cancer incidence; neither percent non-Hispanic white nor Pap screening rate contributed to the ecological associations (although Pap screening rate did mediate the association in the preliminary models).…”

“…However, the burden of these cancers is not distributed equally across the United States: breast cancer incidence is higher, and cervical cancer incidence is lower, in urban areas compared to rural areas (Fogleman, Mueller, & Jenkins, 2015; Singh, 2011). One recent study found that, compared to rates in rural areas, breast cancer incidence rates were 9% higher in urban areas and cervical cancer incidence rates were 15% lower in urban areas (Blake, Moss, Gaysynsky, Srinivasan, & Croyle, 2017). Contrasting the associations of these cancers with potential local influences on health, such as sociodemographics (Pruitt, Shim, Mullen, Vernon, & Amick, 2009; Singh, Williams, Siahpush, & Mulhollen, 2011) and healthcare factors (Belasco, Gong, Pence, & Wilkes, 2014; Doescher & Jackson, 2009), can inform interventions aiming to reduce urban/rural disparities in cancer outcomes and improve overall population health (Wells & Horm, 1998).…”

Urban‐Rural Differences in Aerobic Physical Activity, Muscle Strengthening Exercise, and Screen‐Time Sedentary Behavior

“…Compared to their urban counterparts, US residents who reside in rural settings face an increased risk of premature mortality and health problems such as coronary heart disease, type 2 diabetes, obesity, and numerous types of cancer (including cervical, colorectal, kidney, and lung cancer) . Many of these health challenges have been linked to insufficient physical activity (PA) levels, and it may be that some of the elevated burden of morbidity and premature mortality afflicting rural communities is attributable to lifestyle factors such as lower PA levels .…”