The U.S. cut cancer deaths by 34% since 1991—but not in 458 rural counties

Cancer in the United States experienced a dramatic turnaround in 1991. Prior to that year, cancer deaths had been increasing for decades, peaking at 215 deaths per 100,000 people, meaning about 1 in 4 deaths were attributed to cancer. Then it began to consistently decline, decreasing by 34% between 1991 and 2022. This amounted to an estimated 4.5 million fewer cancer deaths during that period. When the second-most frequent cause of death in the nation begins to decline, the effects are considerable. Improvements in cancer screening, treatment and prevention have led to increases in longevity and well-being. In a diverse country, however, not everyone or every place benefits equally from improvements in health and medicine. In coordination with my colleague Viswadeep Lebakula, research from my team of social scientists and I found that where people live can profoundly influence their chances of dying from cancer. Rural mortality penalty While national data on cancer deaths can provide a useful report card on how successful a country has been on improving its health, it can also mask large geographic differences. My team and I examined cancer deaths rates for almost 3,000 U.S. counties between 1981 and 2019. By looking at cancer mortality at the county level, we found a more complex picture of changing cancer death patterns than just examining the country overall. Specifically, geographic differences between who benefited from the medical and public health improvements that reduced cancer deaths were stark. Large urban centers along both the Atlantic and Pacific coasts consistently had the highest rates of cancer improvements. The heavily populated corridor from Boston to Washington, D.C., had steep declines in cancer deaths. For example, the four largest boroughs in New York City – Manhattan, Queens, Bronx and Brooklyn – saw cancer death rates decline over 40% between 1991 and 2019. The largest and wealthiest borough, Manhattan, had the highest improvement at 47% few