Urban–rural disparities in lung cancer incidence and mortality patterns in Black and White populations

Abstract

Background

Lung cancer mortality trends among Black and White populations and urban compared to rural populations are critical for assessing disparities in cancer outcomes.

Methods

This serial cross-sectional study used US national death certificate data from the National Center for Health Statistics and data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program. The study analyzed lung cancer incidence (2001–2021) and mortality (1990–2021) trends by race, sex, and urban–rural status. Age-adjusted incidence and mortality rates and average annual percent changes (AAPCs) were estimated.

Results

Since 1990, lung cancer death rates have declined faster for Black men, which has reduced the gap with White men, but White women have consistently had higher rates than Black women. Rural areas showed higher incidence and mortality rates compared to urban areas. During 2013–2021, incidence rates declined similarly among urban and rural Black men (AAPC, −3.4 and −4.3, respectively) and White men (AAPC, −3.6 and −2.7, respectively). However, mortality rates decreased faster for urban Black men than for rural Black men (AAPC, −5.4 vs. −4.5) and for urban White men than for rural White men (AAPC, −4.8 vs. −4.0). Incidence and mortality rates declined faster for urban Black and White women than for their rural counterparts.

Conclusions

Although the disparity in lung cancer death rates between Black and White men has narrowed, significant disparities persist between urban and rural populations. The more rapid decline in mortality rates in urban areas suggests that recent treatment advancements may be less accessible to rural populations.