Long-term trends in cancer mortality by rural-urban status, United States, 1969-2023

Understanding long-term trends in cancer mortality in rural and urban areas can provide additional insight into factors contributing to rural-urban disparities in cancer mortality and inform public policies. We examined trends in age-standardized cancer mortality rates (overall, lung, colorectal, female breast, and prostate cancers) by urbanicity of county of residence using National Center for Health Statistics data. During 1969-2023, the highest all-cancer mortality rates shifted from large metropolitan areas to nonmetropolitan areas with the smallest urban population. The crossover occurred in the 1990s in males and early 2000s in females, with the rural-urban mortality gap widening in subsequent years. A similar pattern was observed for lung, colorectal, and breast cancer mortality. The shift in the high cancer burden from urban to rural areas likely reflects geographic redistribution of social determinants of health, which underpins the cancer continuum from exposure to risk factors and prevention to access to high-quality diagnosis and treatment.