Rural Versus Urban Genitourinary Cancer Incidence and Mortality in Pennsylvania: 1990-2019

Our aim was to describe the incidence and mortality of genitourinary (GU) cancers in rural and urban Pennsylvania counties. We calculated age-adjusted incidence and mortality rates of GU (prostate, bladder, and kidney) cancers from 1990 to 2019 in the Pennsylvania Cancer Registry. We defined rurality using the Center for Rural Pennsylvania's population density-based definition. We modeled average annual percent changes (AAPC) in age-adjusted incidence and mortality rates using joinpoint regression. Overall GU cancer incidence decreased in rural and urban counties (AAPC -7.5%, p = 0.04 and AAPC -6.6%, p = 0.02, respectively). Prostate cancer incidence decreased in rural and urban counties by -10.5% (p = 0.02) and -9.1% (p = 0.01), respectively. Kidney cancer incidence increased in both rural and urban counties, respectively (AAPC = +11.2, p = 0.002 and +9.3%, p = 0.01). GU cancer mortality decreased in rural and urban counties (AAPC = -11.6, p = 0.047 and AAPC -12.2, p = 0.01, respectively). Prostate cancer mortality decreased at similar rates in rural and urban counties (AAPC -15.5, p = 0.03 and -15.4, p = 0.02, respectively). Kidney cancer mortality decreased in urban (AAPC -6.9% p = 0.03) but remained stable in rural counties. Bladder cancer incidence and mortality were unchanged in both types of counties. Over three decades, GU cancer incidence and mortality decreased across Pennsylvania counties.