Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014 | Breast Cancer | JAMA | JAMA Network
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1.
GBD 2015 Mortality and Causes of Death Collaborators.  Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.  Lancet. 2016;388(10053):1459-1544.PubMedGoogle ScholarCrossref
2.
Yabroff  KR, Lund  J, Kepka  D, Mariotto  A.  Economic burden of cancer in the US: estimates, projections, and future research.  Cancer Epidemiol Biomarkers Prev. 2011;20(10):2006-2014. PubMedGoogle ScholarCrossref
3.
Ryerson  AB, Eheman  CR, Altekruse  SF,  et al.  Annual report to the nation on the status of cancer, 1975-2012, featuring the increasing incidence of liver cancer.  Cancer. 2016;122(9):1312-1337.PubMedGoogle ScholarCrossref
4.
US Cancer Statistics Working Group. United States Cancer Statistics: 1999-2013 Incidence and Mortality Web-Based Report. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2015. https://nccd.cdc.gov/uscs/. Accessed May 13, 2016.
5.
Lansdorp-Vogelaar  I, Goede  SL, Ma  J,  et al.  State disparities in colorectal cancer rates: contributions of risk factors, screening, and survival differences.  Cancer. 2015;121(20):3676-3683.PubMedGoogle ScholarCrossref
6.
Albano  JD, Ward  E, Jemal  A,  et al.  Cancer mortality in the United States by education level and race.  J Natl Cancer Inst. 2007;99(18):1384-1394.PubMedGoogle ScholarCrossref
7.
Dwyer-Lindgren  L, Mokdad  AH, Srebotnjak  T, Flaxman  AD, Hansen  GM, Murray  CJ.  Cigarette smoking prevalence in US counties: 1996-2012.  Popul Health Metr. 2014;12(1):5.PubMedGoogle ScholarCrossref
8.
Ogden  CL, Carroll  MD, Lawman  HG,  et al.  Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014.  JAMA. 2016;315(21):2292-2299.PubMedGoogle ScholarCrossref
9.
Dwyer-Lindgren  L, Freedman  G, Engell  RE,  et al.  Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action.  Popul Health Metr. 2013;11:7.PubMedGoogle ScholarCrossref
10.
Radley  DC, Schoen  C.  Geographic variation in access to care—the relationship with quality.  N Engl J Med. 2012;367(1):3-6.PubMedGoogle ScholarCrossref
11.
Dwyer-Lindgren  L, Bertozzi-Villa  A, Stubbs  RW,  et al.  US county-level trends in mortality rates for major causes of death, 1980-2014.  JAMA. 2016;316(22):2385-2401.PubMedGoogle ScholarCrossref
12.
National Center for Health Statistics. National Vital Statistics System: Multiple Cause of Death Data File, 1980-2014. Hyattsville, MD: National Center for Health Statistics; 2014.
13.
US Census Bureau. Intercensal county estimates by age, sex, race: 1980-1989. https://www.census.gov/data/datasets/time-series/demo/popest/1980s-county.html. Accessed January 8, 2015.
14.
National Center for Health Statistics. Bridged-race intercensal estimates of the resident population of the United States for July 1, 1990-July 1, 1999, by year, county, single-year of age (0, 1, 2, ..., 85 years and over), bridged race, Hispanic origin, and sex. July 26, 2004. https://www.cdc.gov/nchs/nvss/bridged_race.htm. Accessed November 21, 2011.
15.
National Center for Health Statistics. Bridged-race intercensal estimates of the resident population of the United States for July 1, 2000-July 1, 2009, by year, county, single-year of age (0, 1, 2, ..., 85 years and over), bridged race, Hispanic origin, and sex. October 26, 2012. https://www.cdc.gov/nchs/nvss/bridged_race.htm. Accessed October 30, 2012.
16.
National Center for Health Statistics. Vintage 2014 postcensal estimates of the resident population of the United States (April 1, 2010, July 1, 2010-July 1, 2014), by year, county, single-year of age (0, 1, 2, ..., 85 years and over), bridged race, Hispanic origin, and sex. June 30, 2015. https://www.cdc.gov/nchs/nvss/bridged_race.htm. Accessed December 18, 2015.
17.
University of California, Berkeley, Max Planck Institute for Demographic Research. The Human Mortality Database. http://www.mortality.org/. Accessed July 8, 2013.
18.
Kristensen  K, Nielsen  A, Berg  CW, Skaug  H, Bell  B.  TMB: automatic differentiation and Laplace approximation.  J Stat Softw. 2016;70(5):1-21. doi:10.18637/jss.v070.i05Google ScholarCrossref
19.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2016. https://www.r-project.org/. Accessed March 31, 2016.
20.
GBD 2015 Risk Factors Collaborators.  Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.  Lancet. 2016;388(10053):1659-1724.PubMedGoogle ScholarCrossref
21.
Murray  CJ, Lopez  AD.  On the comparable quantification of health risks: lessons from the Global Burden of Disease Study.  Epidemiology. 1999;10(5):594-605.PubMedGoogle ScholarCrossref
22.
National Cancer Institute. SEER*Stat Database: Incidence—SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973-2013 Varying)—Linked to County Attributes—Total U.S., 1969-2014 Counties. 2016. https://seer.cancer.gov/. Accessed May 13, 2016.
23.
National Cancer Institute. SEER Cancer Statistics Review (CSR) 1975-2010, Table 1.4: Summary of Changes in Cancer Mortality, 1950-2010 and 5-Year Relative Survival Rates, 1950-2009 Males and Females, by Primary Cancer Site. https://seer.cancer.gov/archive/csr/1975_2010/browse_csr.php?sectionSEL=1&pageSEL=sect_01_table.04.html. Accessed June 27, 2016.
24.
Toriola  AT, Colditz  GA.  Trends in breast cancer incidence and mortality in the United States: implications for prevention.  Breast Cancer Res Treat. 2013;138(3):665-673.PubMedGoogle ScholarCrossref
25.
Berry  DA, Cronin  KA, Plevritis  SK,  et al; Cancer Intervention and Surveillance Modeling Network Collaborators.  Effect of screening and adjuvant therapy on mortality from breast cancer.  N Engl J Med. 2005;353(17):1784-1792.PubMedGoogle ScholarCrossref
26.
Dwyer-Lindgren  L, Flaxman  AD, Ng  M, Hansen  GM, Murray  CJL, Mokdad  AH.  Drinking patterns in US counties from 2002 to 2012.  Am J Public Health. 2015;105(6):1120-1127.PubMedGoogle ScholarCrossref
27.
Ghazarian  AA, Trabert  B, Graubard  BI, Schwartz  SM, Altekruse  SF, McGlynn  KA.  Incidence of testicular germ cell tumors among US men by Census region.  Cancer. 2015;121(23):4181-4189.PubMedGoogle ScholarCrossref
28.
Moyer  VA; US Preventive Services Task Force.  Screening for prostate cancer: US Preventive Services Task Force recommendation statement.  Ann Intern Med. 2012;157(2):120-134.PubMedGoogle ScholarCrossref
29.
American Cancer Society. American Cancer Society recommendations for prostate cancer early detection. http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-acs-recommendations. Accessed May 13, 2016.
30.
US Preventive Services Task Force. Final research plan: prostate cancer: screening. April 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/prostate-cancer-screening1. Accessed May 30, 2016.
31.
Centers for Disease Control and Prevention.  State-specific trends in lung cancer incidence and smoking—United States, 1999-2008.  MMWR Morb Mortal Wkly Rep. 2011;60(36):1243-1247.PubMedGoogle Scholar
32.
Lauterstein  D, Hoshino  R, Gordon  T, Watkins  B-X, Weitzman  M, Zelikoff  J.  The changing face of tobacco use among United States youth.  Curr Drug Abuse Rev. 2014;7(1):29-43.PubMedGoogle ScholarCrossref
33.
Ogden  CL, Carroll  MD, Fryar  CD, Flegal  KM. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014. November 2015. NCHS Data Brief 219. https://www.cdc.gov/nchs/products/databriefs/db219.htm. Accessed May 13, 2016.
34.
Mokdad  AH, Bowman  BA, Ford  ES, Vinicor  F, Marks  JS, Koplan  JP.  The continuing epidemics of obesity and diabetes in the United States.  JAMA. 2001;286(10):1195-1200.PubMedGoogle ScholarCrossref
35.
Johnston  R, Poti  JM, Popkin  BM.  Eating and aging: trends in dietary intake among older Americans from 1977-2010.  J Nutr Health Aging. 2014;18(3):234-242.PubMedGoogle ScholarCrossref
36.
Urban  LE, Roberts  SB, Fierstein  JL, Gary  CE, Lichtenstein  AH.  Sodium, saturated fat, and trans fat content per 1,000 kilocalories: temporal trends in fast-food restaurants, United States, 2000-2013.  Prev Chronic Dis. 2014;11:E228.PubMedGoogle Scholar
37.
Rehm  CD, Peñalvo  JL, Afshin  A, Mozaffarian  D.  Dietary intake among US adults, 1999-2012.  JAMA. 2016;315(23):2542-2553.PubMedGoogle ScholarCrossref
38.
Hert  KA, Fisk  PS  II, Rhee  YS, Brunt  AR.  Decreased consumption of sugar-sweetened beverages improved selected biomarkers of chronic disease risk among US adults: 1999 to 2010.  Nutr Res. 2014;34(1):58-65.PubMedGoogle ScholarCrossref
39.
Mokdad  AH.  The Behavioral Risk Factors Surveillance System: past, present, and future.  Annu Rev Public Health. 2009;30:43-54.PubMedGoogle ScholarCrossref
Original Investigation
January 24/31, 2017

Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014

Author Affiliations
  • 1Institute for Health Metrics and Evaluation, University of Washington, Seattle
JAMA. 2017;317(4):388-406. doi:10.1001/jama.2016.20324
Key Points

Question  What are the trends and differences in cancer mortality rates among United States counties from 1980 to 2014?

Findings  In this population-based modeling study of deidentified death records from the National Center for Health Statistics, cancer mortality decreased by a relative 20.1% between 1980 and 2014; however, there were substantial differences among counties throughout this period. For many cancers, there were distinct clusters of counties in different regions with especially high mortality.

Meaning  From 1980-2014, there were important changes in trends, patterns, and differences in cancer mortality among US counties.

Abstract

Introduction  Cancer is a leading cause of morbidity and mortality in the United States and results in a high economic burden.

Objective  To estimate age-standardized mortality rates by US county from 29 cancers.

Design and Setting  Deidentified 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 were used. Validated small area estimation models were used to estimate county-level mortality rates from 29 cancers: lip and oral cavity; nasopharynx; other pharynx; esophageal; stomach; colon and rectum; liver; gallbladder and biliary; pancreatic; larynx; tracheal, bronchus, and lung; malignant skin melanoma; nonmelanoma skin cancer; breast; cervical; uterine; ovarian; prostate; testicular; kidney; bladder; brain and nervous system; thyroid; mesothelioma; Hodgkin lymphoma; non-Hodgkin lymphoma; multiple myeloma; leukemia; and all other cancers combined.

Exposure  County of residence.

Main Outcomes and Measures  Age-standardized cancer mortality rates by county, year, sex, and cancer type.

Results  A total of 19 511 910 cancer deaths were recorded in the United States between 1980 and 2014, including 5 656 423 due to tracheal, bronchus, and lung cancer; 2 484 476 due to colon and rectum cancer; 1 573 593 due to breast cancer; 1 077 030 due to prostate cancer; 1 157 878 due to pancreatic cancer; 209 314 due to uterine cancer; 421 628 due to kidney cancer; 487 518 due to liver cancer; 13 927 due to testicular cancer; and 829 396 due to non-Hodgkin lymphoma. Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population. There were large differences in the mortality rate among counties throughout the period: in 1980, cancer mortality ranged from 130.6 (95% UI, 114.7-146.0) per 100 000 population in Summit County, Colorado, to 386.9 (95% UI, 330.5-450.7) in North Slope Borough, Alaska, and in 2014 from 70.7 (95% UI, 63.2-79.0) in Summit County, Colorado, to 503.1 (95% UI, 464.9-545.4) in Union County, Florida. 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.

Conclusions and Relevance  Cancer mortality declined overall in the United States between 1980 and 2014. Over this same period, there were important changes in trends, patterns, and differences in cancer mortality among US counties. These patterns may inform further research into improving prevention and treatment.

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