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Cancer-related mortality has been declining in the United States, but this decline is less in rural areas due to urban–rural healthcare gaps.

Cancer is the leading cause of mortality in the United States. While U.S. cancer mortality rates have declined in recent decades, this decline has not been uniform across all sociodemographic groups. Data shows that there is a difference in cancer mortality rates in urban and rural areas. Rural communities have generally poorer outcomes, especially concerning preventable cancers. This is due to the slower dissemination of medical advancements and differences in cancer care. Cancer screening rates are also lower in rural areas. 

In the United States, about one-fifth of Americans live in rural areas. A new study published in Cancer Medicine explores this urbanrural divide. 

UrbanRural Divide and Non-Hodgkin Lymphoma Mortality

The study looked into cancer trends, focusing on the urbanrural divide. The cancer mortality trend between 1999 and 2020 was analyzed. For the purpose of the study, researchers used U.S.-wide data from the National Center for Health Statistics. It included all those diagnosed with cancer and aged 25 years or older and looked at the overall cancer mortality trend. It found that there was a statistically significant decline in cancer-related mortality during the last two decades. 

However, it also found that the average annual percentage change (AAPC) in cancer-related mortality was more significant in urban areas than in rural areas (1.96 vs. 1.43), thus identifying a significant urban–rural gap. Researchers also analyzed the data for various common cancer types. Sub-data analysis found the same trend for non-Hodgkin’s lymphoma mortality rates. The AAPC for non-Hodgkin’s lymphoma in urban areas was 2.58, whereas for rural areas it was 2.13. 

The Bottom Line

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The authors noted that previous studies show that these differences in urban and rural areas are due to structural and environmental disadvantages in rural areas, such as delays in screening, lower clinical trial enrollment, and treatment facility capacity in rural areas. Patients in many rural areas do not have access to specialists, so they must travel great distances for medical care. To eliminate these disparities in cancer mortality, there is a need to enhance cancer preventive services, vaccination, and guideline-adherent cancer care in rural areas.


Sokale, I. O., Syed Ahsan Raza, & Thrift, A. P. (2023). Disparities in cancer mortality patterns: A comprehensive examination of U.S. rural and urban adults, 1999–2020. Cancer Medicine, 12(18), 18988–18998. https://doi.org/10.1002/cam4.6451