Record Details

Title Urban-rural Gradients in Cancer Incidence and Mortality in the United States
Author Howe, HL
Secondary Authors
Publication Type (Help) booklet
Month August
Year 2004
How Published
PubMed ID
EPub Date
Citation Howe HL. Urban-rural Gradients in Cancer Incidence and Mortality in the United States. Springfield, IL: North American Association of Central Cancer Registries, August 2004. []


This study describes urban-rural gradients in cancer incidence and mortality in the United States. The 1995-1999 NAACCR data set covering 34% of the U.S. population and 2.1 million cancer cases and 1996-99 cancer deaths for the United States as compiled by the National Vital Statistics System were used for the analyses. Cancer incidence and death rates were calculated by sex, site, race, and Beale category. The Beale urban-rural continuum assigns U.S. counties into 1 of 10 categories based on population count, proximity to larger metropolitan areas, and work commuting patterns. The gradients in rates of the site- and sex-specific cancer rates by Beale categories were compared using linear regression and were considered statistically significant at p < 0.05, with the adjusted R2 used to explain the strength of the gradient. Furthermore, several area socioeconomic measures for the white population were examined for their linear association with the Beale urban-rural indicator. Statistically significant urban-rural trends occurred similarly for age-adjusted cancer incidence and cancer death rates. Nearly all incidence trends declined from urban to rural areas, with the exception of lip cancer in males and lung and oral cavity cancers in females. The gradients in age-adjusted cancer death rates had more increasing urban-rural trends than did cancer incidence rates. The increasing trends for deaths included cancers of the lip, liver, and lung, and non-Hodgkin lymphoma in males and cancers of the cervix and breast, and non-Hodgkin lymphoma in females. The urban-rural measure correlated strongly with all area socio-economic status (SES) indicators. Urban-rural gradients are evident for many incident cancers and cancer deaths. The gradients differ among different cancer types, although most suggest higher age-adjusted rates among more urban populations.


united states