The overall rate of death from cancer declined about 20 percent between 1980 and 2014; however, there are distinct clusters of counties in the U.S. with particularly high cancer mortality rates, according to a study in the January 24/31 issue of JAMA.
Cancer is the second leading cause of death in the United States and globally. Most previous reports on geographic differences in cancer mortality in the U.S. have focused on variation by state, with less information available at the county level. There is a value for data at the county level because public health programs and policies are mainly designed and implemented at the local level. Moreover, local information can also be useful for health care clinicians to understand community needs for care and aid in identifying cancer hot spots that need more investigation to understand the root causes.
Christopher J. L. Murray, M.D., D.Phil., of the Institute for Health Metrics and Evaluation, University of Washington, Seattle, and colleagues estimated mortality rates by U.S. county from 29 cancers using death records from the National Center for Health Statistics (NCHS) and population counts from the Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014.
The researchers found that cancer mortality decreased by 20.1 percent between 1980 and 2014, from 240 to 192 deaths per 100,000 population. A total of 19,511,910 cancer deaths were recorded in the United States during this period, including:
- 5.7 million due to tracheal, bronchus, and lung cancer;
- 2.5 million due to colon and rectum cancer;
- 1.6 million due to breast cancer;
- 1.2 million due to pancreatic cancer;
- 1.1 million due to prostate cancer.
For many cancers, there were distinct clusters of counties with especially high mortality. The location of these clusters varied by type of cancer and were spread in different regions of the United States. Clusters of breast cancer were present in the southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska, and Illinois.
"The study was able to identify clusters of high rates of change among U.S. counties, which is important for providing data to inform the debate on prevention, access to care, and appropriate treatment. Indeed, monitoring cancer mortality at the county level can help identify worsening incidence, inadequate access to quality treatment, or potentially other etiological factors involved," the authors write.
(doi:10.1001/jama.2016.20324; the study is available pre-embargo at the For the Media website)
Editor's Note: This work was funded by the Robert Wood Johnson Foundation, the National Institute on Aging and John W. Stanton and Theresa E. Gillespie. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Related material: The editorial, "Translating Cancer Surveillance Data Into Effective Public Health Interventions," by Stephanie B. Wheeler, Ph.D., M.P.H., and Ethan Basch, M.D., M.Sc., of the University of North Carolina at Chapel Hill, and Associate Editor, JAMA (Dr. Basch), also is available at the For The Media website.
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