Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa.
Department of Sociology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey.
Cancer Epidemiol Biomarkers Prev. 2024 Aug 1;33(8):1012-1022. doi: 10.1158/1055-9965.EPI-24-0072.
Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural-urban differences in cancer incidence and trends.
We used the North American Association of Central Cancer Registries dataset to investigate rural-urban differences in 5-year age-adjusted cancer incidence (2015-2019) and trends (2000-2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEER∗Stat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APC).
We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared with urban areas (447.9), with the largest rural-urban difference in the South (464.4 vs. 449.3). Rural populations also exhibited higher rates of tobacco-associated, human papillomavirus-associated, and colorectal cancers, including early-onset cancers. Tobacco-associated cancer incidence trends widened between rural and urban from 2000 to 2019, with significant, but varying, decreases in urban areas throughout the study period, whereas significant rural decreases only occurred between 2016 and 2019 (APC = -0.96). Human papillomavirus-associated cancer rates increased in both populations until recently with urban rates plateauing whereas rural rates continued to increase (e.g., APC = 1.56, 2002-2019).
Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared with urban populations. Improvements in these rates were typically slower in rural populations.
Our findings underscore the complex nature of rural-urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.
尽管癌症预防和治疗方面不断取得进展，但美国农村和城市的癌症发病率仍存在差异。我们的目的是进一步研究癌症发病率的城乡差异和趋势。
我们使用北美癌症登记协会数据集，调查了 2015-2019 年（2000-2019 年）农村和城市地区 5 年年龄调整后癌症发病率的城乡差异，还按地区、性别、种族和肿瘤部位进行了差异分析。使用 SEER*Stat 8.4.1 计算年龄调整率，使用 Joinpoint 进行趋势分析，报告年百分比变化（APC）。
我们观察到农村地区所有癌症合并 5 年发病率（457.6/100,000）高于城市地区（447.9/100,000），南部地区城乡差异最大（464.4/100,000 与 449.3/100,000）。农村人群还表现出更高的烟草相关、人乳头瘤病毒相关和结直肠癌发病率，包括早发性癌症。2000 年至 2019 年，农村和城市地区的烟草相关癌症发病率趋势逐渐扩大，整个研究期间城市地区显著下降，但农村地区仅在 2016 年至 2019 年期间显著下降（APC=-0.96）。人乳头瘤病毒相关癌症发病率在两个地区均有所上升，直到最近城市地区趋于平稳，而农村地区仍在继续上升（例如，APC=1.56，2002-2019 年）。
与城市人群相比，农村人群的总体癌症发病率更高，且具有预防机会的癌症发病率更高。这些发病率的改善在农村人群中通常较慢。
我们的研究结果强调了城乡差异的复杂性，强调需要采取有针对性的干预措施和政策，以减少差异，实现公平的健康结果。
