Who is benefiting from the dramatic decline in U.S. cancer mortality? Place-based evidence of disparities in rates of improvement
After decades of increasing cancer mortality, U.S. rates declined from 1991 to 2019, a 32% decrease. we investigated rates of cancer mortality improvement across 2954 counties and selected characteristics associated with mortality improvements. Data was 21,381,009 county-level neoplasm deaths gleaned from death certificates via CDC WONDER. Analytical techniques included GIS and Moran’s I, OLS, GWR models, and trend comparisons. Counties with the greatest improvement (reduction) in cancer mortality tended to be coastal, higher-income, metropolitan locations. OLS model (R 2 = 0.65) indicated that greatest improvements were observed in counties with higher initial mortality ($\beta =.32$) closely followed by percent urban ($\beta =.31$) and median household income ($\beta =.16$). Whereas percent Black residents ($\beta =-.06$), and percent with education beyond high school ($\beta =-.10$) was less associated on outcomes. Highest income counties were the first to experience improvement in cancer mortality, the highest rates of mortality decline, and the greatest reduction in excess deaths. Even though there was significant improvement in cancer mortality nationally, there were variations in the degree of improvement linked to county location, income, and urbanisation. These results underlie the need to expand place-based initiatives designed to advance cancer health and more equitable improvements in cancer mortality outcomes.