Disparities in cancer mortality patterns: A comprehensive examination of U.S. rural and urban adults, 1999–2020

BACKGROUND: Cancer mortality rates overall in the U.S. have decreased significantly; however, the rate of decline has not been uniform across sociodemographic groups. We aimed to compare trends in cancer mortality rates from 1999 to 2020 between rural and urban individuals and to examine whether any rural–urban differences are uniform across racial and ethnic groups. METHODS: We used U.S.‐wide data from the National Center for Health Statistics, for all cancer deaths among individuals aged 25 years or older. We estimated average annual percentage change (AAPC) in age‐standardized cancer mortality rates in the U.S. by cancer type, rural–urban status, sex, and race and ethnicity. RESULTS: There was a larger reduction in cancer mortality rates among individuals from urban (males: AAPC, −1.96%; 95% CI, −2.03, −1.90; females: AAPC, −1.56%; 95% CI, −1.64, −1.48) than rural (males: AAPC, −1.43%; 95% CI, −1.47, −1.39; females: AAPC, −0.93; 95% CI, −1.03, −0.82) areas. AAPCs for cancer types were uniformly higher among urban areas compared with rural areas. Despite overall decreases, deaths rates for liver and pancreas cancers increased, including in the most recent period among males (2012–2020, APC, 1.34; 95% CI, 0.49, 2.20) and females (2013–2020, APC, 1.52; 95% CI, 0.03, 3.02) in rural areas. CONCLUSIONS: Cancer death rates decreased in all racial and ethnic populations; however, the rural–urban differences varied by race/ethnicity. The rate of decline in mortality rates were lower in rural areas and death rates for liver and pancreas cancers increased, particularly for individuals living in rural America.