Rural–Urban Differences in Cancer Incidence and Trends in the United States

Abstract

Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends. We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013. Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, < 0.05), while temporal trends remained stable in urban areas. Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations. Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations.

Public perception of predictive cancer genetic testing and research in Oregon

“…Although rural communities are defined differently by government groups, they comprise 15%–19% of the US population and 72%–95% of US land (Rural Health Research Center, 2019; United States Census Bureau, 2017; United States Department of Agriculture, 2019). Rural communities often experience geographic isolation, high poverty rates, and lack of services, particularly in regard to health care (Blake et al, 2017; Singh, Williams, Siahpush, & Mulhollen, 2011; Zahnd et al, 2018). It is noteworthy that many metropolitan communities can still experience geographic isolation and/or health service shortages (Health Resources & Services Administration, 2018).…”

“…The Oregon Office of Rural Health defines a rural community as any geographic area ten or more miles from an urban area with a population of 40,000 or more, and a frontier community as any county with six or fewer people per square mile (Oregon Office of Rural Health, 2019a). One third of Oregon's population lives in rural communities (Oregon Office of Rural Health, 2019a), which often have lower access to medical centers, lower employment, higher poverty, and greater health disparities relative to urban communities (Blake et al, 2017; Bolin et al, 2015; Zahnd et al, 2018). In Oregon, individuals within frontier communities have longer drives on average (15.3 min) to access the nearest patient‐centered primary care ‘homes’ than do those within rural (12.5 min) or urban areas (10 min), with several areas requiring over 30‐min drives or longer, such as in southeast Oregon where residents have to drive over one hour (77 min) to get to a facility (Oregon Office of Rural Health, 2019b).…”

Concordance of Rural‐Urban Self‐identity and ZIP Code‐Derived Rural‐Urban Commuting Area (RUCA) Designation

“…For example, risk behaviors such as smoking, obesity, and low physical activity have been shown to be higher in rural areas . Higher rates of mortality and disease incidence, such as for cancer, have been well documented in rural areas, and psychosocial differences in health‐related beliefs have been shown …”

Effect of rural and urban geography on larynx cancer incidence and survival

“…Disparities in incidence, treatment, and survival of larynx cancer by urban and rural geography have not been well described. Prior studies have shown that nonmetropolitan, rural counties have higher incidence and mortality rates for tobacco‐related cancer . Because rural areas are characterized by greater poverty and higher rates of tobacco use, such areas may be expected to bear a disproportionate burden of larynx cancer incidence and mortality.…”