Cancer Mortality Trends in the United States Vary Widely by County From 1980 to 2014
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 U.S. counties. These patterns may inform further research into improving prevention and treatment.
— Ali H. Mokdad, PhD, and colleagues
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In a study reported in JAMA, Ali H. Mokdad, PhD, and colleagues from the University of Washington, Seattle, found that cancer mortality rates in the United States dropped from 240.2 to 192.0 per 100,000 population between 1980 and 2014.1 Mortality rates varied widely among U.S. counties for various cancers. The report covers 29 cancers in 3,144 counties. Findings for tracheal, bronchial, and lung cancers; colon and rectal cancers; breast, prostate, pancreatic, uterine, kidney, and liver cancers; and non-Hodgkin lymphoma are summarized below.
Christopher J.L. Murray, MD, DPhil, of the University of Washington Institute for Health Metrics and Evaluation, is the corresponding author for the JAMA article.
The study used de-identified death records from the National Center for Health Statistics and population counts from the Census Bureau, the National Center for Health Statistics, and the Human Mortality Database from 1980 to 2014. Age-standardized mortality rates were estimated.
A total of 19,511,910 cancer deaths were recorded in the United States between 1980 and 2014. Mortality decreased from 240.2 to 192.0 per 100,000 population over this time, representing a 20.1% decrease.
In 2014, the lowest cancer mortality rate was 70.7 in Summit County, Colorado, and the highest rate was 503.1 in Union County, Florida. In that final year of the analysis, there were clusters of high mortality in several areas of the South (in Kentucky, West Virginia, Alabama, and along the Mississippi River) and in Western Alaska and counties in North and South Dakota and Texas; lower rates were observed in counties in Utah and Colorado. Significant increases in mortality were observed in 160 counties, with the highest in Kentucky and scattered regions in the South.
Christopher J.L. Murray, MD, DPhil
Tracheal, Bronchial, and Lung Cancer
- A total of 5,656,423 deaths were recorded; mortality decreased from 68.6 to 54.2 per 100,000, a 21.0% reduction.
- Reductions in cancer mortality rate were observed in the West and Northeast and Florida, and increases were observed in the South, Appalachian region, and Midwest. The largest increase was observed in Owsley County, Kentucky (99.7%), and the greatest decrease was in Aleutians East Borough and Aleutians West Census Area (63.6%).
- In 2014, high rates were clustered in Kentucky and West Virginia, and low rates were observed along the border with Mexico and in Utah; Colorado; and parts of Arizona, New Mexico, and Idaho. Rates varied from 10.6 in Summit County, Colorado, to 334.9 per 100,000 in Union County, Florida, for males and from 10.9 in Summit County, Colorado, to 121 per 100,000 in Owsley County, Kentucky, for females.
Colon and Rectal Cancer
- A total of 2,484,476 deaths were recorded; the rate dropped from 34.3 to 22.1 per 100,000, a 35.5% decrease. The greatest decrease occurred since 2001.
- In 2014, the highest rate was in Union County, Florida (58.4/100,000) and the lowest was in Summit County, Colorado (8.1/100,000). High rate clusters were found along the Mississippi River in Missouri, Mississippi, Arkansas, and Louisiana, with others in southern Alabama, Alaska, and along the border of West Virginia and Kentucky. High rates were also found in counties in Nevada, North and South Dakota, and Montana.
- Significant declines were observed in 2,420 counties, with the greatest in Howard County, Maryland (64.2%), and Nassau County, New York (62.3%).
- A total of 1,573,593 deaths were recorded; the rate dropped from 21.2 to 14.3 per 100,000, a 32.7% reduction.
- The largest decreases were observed in the Northeast, southern Florida, and parts of the northern Midwest. Significant declines were observed in 1,910 counties, with the greatest observed in Summit County, Colorado (55.3%), and Nassau County, New York (54.9%).
- In 2014, rates ranged from 11.3 in Summit County, Colorado, to 51.8 per 100,000 in Madison County, Mississippi. High rate clusters were found in the southern belt and along the Mississippi River. Lower rates were found in parts of the West, Midwest, and Northeast.
- A total of 1,077,030 deaths were recorded; the rate dropped from 13.0 to 10.2 per 100,000, a 21.7% decrease.
- Significant reductions in rates were observed in 1,558 counties, with changes ranging from a 69.4% decrease in Aleutians East Borough and Aleutians West Census Area to a 26.1% increase in Owsley County, Kentucky.
- In 2014, rates varied from 10.0 in Summit County, Colorado, to 64.1 per 100,000 in Madison County, Mississippi. High cluster patterns similar to those found for breast cancer were present in the southern belt and along the Mississippi River, with counties in Alabama, Georgia, South Carolina, and Virginia also having high rates. Lower rates were found in counties in southern Florida and along the U.S. border with Mexico.
- A total of 1,157,878 deaths were recorded; the rate dropped from 13.0 to 12.8 per 100,000, a 1.8% decrease.
- Changes ranged from an increase of 51.7% in Union County, Florida, to a decrease of 46.2% in Aleutians East Borough and Aleutians West Census Area. Increases were found throughout the country, with clusters of larger increases in Kentucky, Kansas, and northeastern Pennsylvania. Decreased rates were found in southern Texas, California, and the Dakotas.
- In 2014, rates were lowest in counties in Colorado, Florida, Arizona, and two regions in Texas and highest in the South along the Mississippi River delta and in counties in Alabama, Georgia, North and South Carolina, Virginia, and Kentucky.
- A total of 209,314 deaths were recorded; rates declined from 2.5 to 2.1 per 100,000, a 16.1% decrease. Declines were not steady.
- Larger declines were found in many counties in California, Colorado, Nevada, and Arkansas, whereas increasing rates were found in clusters in northern Maine, Iowa, Texas, the Carolinas, Virginia, and West Virginia. In 2014, the highest rates were found in these regions and high rates were also found in counties in Montana, New Hampshire, and Vermont.
- A total of 421,628 deaths were recorded; rates were unchanged at approximately 4.6 per 100,000.
- Decreased rates were found in the Northeast and in southern Florida, whereas increases were seen in a wide zone including most counties in the South and Midwest, as well as in the Pacific Northwest and Utah.
- In 2014, rates ranged from 2.1 in Summit County, Colorado, to 9.7 per 100,000 in Buffalo County, South Dakota. Counties in Colorado and southern Florida had very low rates, whereas clusters of high rates were found along the Mississippi Delta, Oklahoma, Texas, North and South Dakota, and counties in West Virginia, Ohio, Indiana, Illinois, Alaska, and some counties with large Native American populations in South Dakota, North Dakota, and the Four Corners area.
- A total of 487,518 deaths were recorded; rates increased from 3.6 to 6.8 per 100,000, an increase of 87.6%.
- In 2014, rates ranged from 2.3 in Summit County, Colorado, to 37.6 per 100,000 in Anderson County, Texas. Almost all counties (3,069) had significant increases in death rates, with many counties on the West Coast and in New Mexico and West Texas having very large increases. High rates were found in a cluster of counties along the Mexico border in Texas and in counties with large Native American populations in South Dakota, New Mexico, and Alaska.
- A total of 829,396 deaths were recorded; mortality rates were unchanged at 8.3 per 100,000.
- Rates increased markedly in a cluster of counties in West Virginia and eastern Kentucky and in a belt of counties from Alabama through South Carolina, whereas declining rates were observed in many counties in New England, Nevada, California, Florida, and Alaska. In 2014, low rates were found in the Four Corners area, Alaska, and some counties on the Texas-Mexico border. Higher rates were found throughout the Midwest, with especially high rates in southern Louisiana, Michigan, Iowa, the Appalachian region, Indiana, Ohio, and Pennsylvania.
- The investigators concluded: “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 U.S. counties. These patterns may inform further research into improving prevention and treatment.” ■
Disclosure: The study was funded by the Robert Wood Johnson Foundation, National Institute on Aging, and John W. Stanton and Theresa E. Gillespie. The authors reported no potential conflicts of interest.
1. Mokdad AH, Dwyer-Lindgren L, Fitzmaurice C, et al: Trends and patterns of disparities in cancer mortality among US counties, 1980-2014. JAMA 317:388-406, 2017.
Poor outcomes in a specific disease in which treatment is often successful may be a sign of health systems issues. It may signal that a significant proportion of the population is unable to get adequate health care.
— Otis W. Brawley, MD, MACP
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