Trends and patterns of disparities in cancer mortality among US counties, 1980–2014

Abstract

Cancer is a leading cause of morbidity and mortality in the United States and results in a high economic burden.

OBJECTIVE 

To estimate age-standardized mortality rates by US county from 29 cancers.

DESIGN AND SETTING 

Deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014 were used. Validated small area estimation models were used to estimate county-level mortality rates from 29 cancers: lip and oral cavity; nasopharynx; other pharynx; esophageal; stomach; colon and rectum; liver; gallbladder and biliary; pancreatic; larynx; tracheal, bronchus, and lung; malignant skin melanoma; nonmelanoma skin cancer; breast; cervical; uterine; ovarian; prostate; testicular; kidney; bladder; brain and nervous system; thyroid; mesothelioma; Hodgkin lymphoma; non-Hodgkin lymphoma; multiplemyeloma; leukemia; and all other cancers combined.

RESULTS 

A total of 19,511,910 cancer deaths were recorded in the United States between 1980 and 2014, including 5,656,423 due to tracheal, bronchus, and lung cancer; 2,484,476 due to colon and rectum cancer; 1,573,593 due to breast cancer; 1,077,030 due to prostate cancer; 1,157,878 due to pancreatic cancer; 209,314 due to uterine cancer; 421,628 due to kidney cancer; 487,518 due to liver cancer; 13,927 due to testicular cancer; and 829,396 due to non-Hodgkin lymphoma. Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%–21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8–244.1) to 192.0 (95% UI, 188.6–197.7) deaths per 100,000 population. There were large differences in the mortality rate among counties throughout the period: in 1980, cancer mortality ranged from 130.6 (95% UI, 114.7–146.0) per 100,000 population in Summit County, Colorado, to 386.9 (95% UI, 330.5–450.7) in North Slope Borough, Alaska, and in 2014 from 70.7 (95% UI, 63.2–79.0) in Summit County, Colorado, to 503.1 (95% UI, 464.9–5 5.4) in Union County, Florida. For many cancers, there were distinct clusters of counties with especially high mortality. The location of these clusters varied by type of cancer and were spread in different regions of the United States. Clusters of breast cancer were present in the southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska, and Illinois.

CONCLUSIONS AND RELEVANCE 

Cancer mortality declined overall in the United States between 1980 and 2014. Over this same period, there were important changes in trends, patterns, and differences in cancer mortality among US counties. These patterns may inform further research into improving prevention and treatment.