There is an urban versus rural divide in the trajectory of lung cancer rates in the United States. While rates of lung cancer are declining for both men and women across the board, the decline is much less steep for people who don’t live in or near cities.

Publishing their findings in Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention (CDC) researchers analyzed U.S. Cancer Statistics data covering 2007 to 2016.

During this 10-year period, lung cancer rates declined among both men and women overall.

Among women, rates in nonmetropolitan counties were stable among those younger than 35, those 45 to 64 years old and those 75 years old or older. Rates were also stable among women younger than 35 in metropolitan counties. Among women in all other age groups, regardless of place of residence, rates declined.

Among men, lung cancer rates declined in all groups. Specifically, rates decreased from 99 to 82 diagnoses per 100,000 residents in nonmetropolitan areas and from 83 to 63 diagnoses per 100,000 residents in metropolitan areas. Among women, the diagnosis rate per 100,000 people declined more slowly, from 61 to 58 diagnoses in nonmetropolitan areas and from 57 to 50 diagnoses in metropolitan areas.

In 2007, the diagnosis rate among men in nonmetropolitan counties was 99 diagnoses per 100,000 men, a rate 60% higher than the 61 diagnoses per 100,000 women among their female counterparts. In 2016, the rate in nonmetropolitan areas was 82 diagnoses per 100,000 people among men, a 40% higher rate than the 58 diagnoses per 100,000 people among women.

Over the 10-year study period, the average annual percentage change in the lung cancer diagnosis rate in metropolitan areas was steeper among men (-2.9%) and women (-1.5%) than the declines in nonmetropolitan areas among men (-2.1%) and women (-0.5%).

Among men, the largest average annual percentage decline in the lung cancer diagnosis rate was among those 45 to 54 years old in metropolitan counties (-5.2%) and those 35 to 44 years old in nonmetropolitan counties (-5.0%).

The largest decline among women in the average annual percentage change in the lung cancer rate was among those 35 to 44 years old in metropolitan counties (-5.0%). Among women in nonmetropolitan counties, the rates declined among those 35 to 44 years old (-3.6%) and 65 to 74 years old (-1.3%) while holding steady in all other age groups.

In 2016, among those 55 years old and older, the highest lung cancer rates were seen among men in nonmetropolitan counties. Among those 35 to 54 years old, rates were comparable between the sexes in both metropolitan and nonmetropolitan counties but were higher overall in nonmetropolitan counties. Among those 35 to 64 years old, rates were higher among women in nonmetropolitan counties than among men in metropolitan counties.

According to 2017 data from the National Health Interview Survey, compared with adults living in metropolitan areas, those living in nonmetropolitan areas reported a higher rate of current cigarette smoking (23% versus 13%) and, among smokers, a lower rate of attempting to quit (50% versus 56%) and of successfully quitting (5% versus 9%).

The new data point toward solutions, according to the report. The authors note that lung cancer prevention requires a comprehensive approach that includes tobacco cessation, testing homes for radon, using proven methods to lower high radon levels and reducing exposure to lung carcinogens such as asbestos. Increasing these “proven population-based lung cancer prevention and control strategies” for people who live in rural areas, they conclude, may help reduce these disparities in lung cancer rates.  

To read the CDC report, click here.

To learn more about lung cancer, including prevention, click here.