Geography Drives Disparities in Cancer Mortality Decline

Research into United States cancer mortality trends reveals a significant national decline in deaths between 1991 and 2019, with an overall decrease of 32%. However, this improvement has not been distributed evenly, as geographic location, income levels, and urbanization increasingly determine who benefits from these advancements.

Data from 21,381,009 county-level neoplasm deaths sourced from CDC WONDER indicates that the most substantial reductions in cancer mortality occurred in coastal, higher-income, and metropolitan areas.

Factors Driving Mortality Improvements

An Ordinary Least Squares (OLS) model used to analyze the data found that the greatest improvements in cancer mortality were observed in counties characterized by higher initial mortality rates, a higher percentage of urban residents, and higher median household income.

The analysis specifically highlighted that highest-income counties were the first to experience improvements in cancer mortality. These areas also saw the highest rates of mortality decline and the most significant reduction in excess deaths.

In contrast, factors such as the percentage of Black residents and the percentage of residents with education beyond high school were found to be less associated with the outcomes of mortality improvement.

The Widening Rural-Urban Gap

While national rates have declined, the burden of cancer has shifted from urban to rural areas. According to two studies from the American Cancer Society reported on March 18, 2026, the mortality gap between urban and rural residents continues to widen.

This disparity is evident in specific cancer types. For instance, prostate cancer mortality rates were comparable across different levels of urbanicity between 1969 and 1971. However, by the period of 2021 to 2023, mortality rates were higher in non-large metropolitan areas than in large metropolitan centers.

The American Cancer Society attributes the higher mortality rates in rural areas to several intersecting social determinants of health, including:

• Limited access to medical care
• Lower rates of cancer screening
• Higher levels of poverty
• A higher prevalence of smoking and other cancer-causing factors

Public Health Implications

The persistence of these geographic and racial disparities suggests that the benefits of medical advancements in cancer treatment and prevention are not reaching all populations equally.

Differences in cancer risk factors, and in access to early detection and treatment, are likely major contributors to this shift in the high cancer burden from urban to rural areas

Dr. Farhad Islami, senior scientific director, cancer disparity research at the American Cancer Society

Dr. Islami further noted that these trends largely reflect growing inequalities in social determinants of health, which encompass the environmental conditions where individuals are born, live, work, and age.

Because place significantly influences health outcomes, researchers emphasize the necessity of expanding place-based initiatives. These initiatives are designed to advance cancer health and create more equitable improvements in mortality outcomes across all U.S. Counties.