In poorer areas, cancer deaths soar, study says
CHICAGO — Americans in certain struggling parts of the country are dying from cancer at rising rates, even as the cancer death rate nationwide continues to fall, an exhaustive new analysis has found.
In parts of the country that are relatively poor — and have higher rates of obesity and smoking — cancer death rates rose nearly 50 percent, while wealthier pockets of the country saw death rates fall by nearly half.
Better screening and treatment have contributed to the improvement in the nation as a whole, but the study underscores that not all Americans have benefited from these advances.
“We are going in the wrong direction,” said Ali Mokdad, the study’s lead author and a professor at the University of Washington’s Institute for Health Metrics and Evaluation. “We should be going forward, not backward.”
S t a r k d i f f e r e n c e s i n r e g i o n a l c a n c e r d e a t h rates have been found in previous research, but this study stands out for providing detailed estimates for deaths from nearly 30 types of cancer in all 3,100 U.S. counties over 35 years.
From 1980 to 2014, the U.S. death rate per 100,000 people for all cancers com- bined dropped from about 240 to 192 — a 20 percent decline. More than 19 million Americans died from cancer during that time, the study found.
The picture was rosiest in the Colorado ski country, where cancer deaths per 100,000 residents dropped by almost half, from 130 in 1980 to just 70 in 2014; and bleakest in some eastern Kentucky counties, where they soared by up to 45 percent.
“We all know this is unacceptable ... in a country that spends more than anybody else on health,” Mokdad said.
The Affordable Care Act took effect in the study’s final years and emphasized prevention services, including no-cost screenings for breast, colorectal and cervical cancers. Any resulting benefits wouldn’t be evident in the latest results, since cancer takes years to develop. It’s unknown whether similar coverage will be part of the replacement system the Trump administration and congressional Republicans are seeking.
An editor ial publi shed with the study by Stephanie Wheeler, a Universit y of North Carolina health poli c y spec i al i s t and Dr. Ethan Basch, a University of North Carolina c ancer specialist, notes that many areas with the highest cancer death rates also strongly supported Donald Trump, “raising hopes that future policies developed by the incoming administration will provide resources” for these communities.
Researchers estimated count y death rates using U. S . g o v e r n me n t d e a t h records and U. S. Census Bureau data. Results were published Tuesday in the Journal of the American Medical Association.
Among the more striking disparities:
■ In counties with the highest 2014 cancer death rates, six of the top 10 were in eastern Kentucky. Six of the 10 lowest rates were in the Colorado Rockies.
■ For lung cancer deaths, four of the five counties with the highest 2014 rates were in eastern Kentucky, with rates up to 80 percent higher than in 1980. Three of the five counties with the lowest 2014 rates were in the Colorado Rockies, where rates dropped by up to 60 percent.
■ Death rates for breast a n d c o l o r e c t a l c a n c e r s increased in Madison County, Miss., and in 2014 were at least five times higher there t han i n Summit C ount y, Colo., where the rates fell.
Smoking, obesity, physical activity and income explain many of the disparities, said study co-author Dr. Christopher Murray, also at the University of Washington.