Rural-Urban Cancer Death Gap Widens as Studies Show Local Care Can Match Big-City Results

Rural residents face an increasingly larger share of cancer deaths in the United States, with the gap continuing to widen between them and their urban counterparts, according to a new study. However, separate research suggests that some rural cancer patients may not need to travel long distances to big-city medical centers for quality surgical care.

A study published in the Journal of the National Cancer Institute found that rural areas had the highest cancer death rates from 2021 to 2023, while large cities had the lowest rates. Researchers analyzed data from nearly 28 million cancer deaths that occurred in the U.S. between 1969 and 2023, using records from the U.S. National Center for Health Statistics. The findings represent a significant long-term shift: between 1969 and 1971, large cities actually had the highest overall cancer death rates, followed by small- to medium-sized cities.

The crossover in death rates occurred in the 1990s for men and the early 2000s for women, and the urban-rural death gap has continued to widen since then. For example, lung cancer deaths among men in rural areas were 26% lower compared to city dwellers in 1969 to 1971, but 55% higher in 2021 to 2023. Researchers said the higher risk among rural residents is likely driven by limited access to health care, lower cancer screening rates, higher poverty, more smoking, and other lifestyle and environmental factors.

"Differences in cancer risk factors, and in access to early detection and treatment, are likely major contributors to this shift in the high cancer burden from urban to rural areas," said the study's lead researcher. The analysis found evidence of this shift even when looking at specific cancers including lung, colon, and breast cancers.

Meanwhile, a study published in the Journal of the American College of Surgeons found that lung or colon cancer patients treated at local hospitals had similar death rates and surgical outcomes to those who traveled to big-city medical centers. Researchers analyzed outcomes of nearly 10,400 rural residents with colon cancer and more than 6,000 with lung cancer. All patients were 65 or older and covered by Medicare.

More than half — 54% — of colon cancer patients and a quarter of lung cancer patients underwent surgery at a local hospital. Death rates after three months were about 5% for lung cancer patients and 7% for colon cancer patients, regardless of whether they were treated at a local hospital or an urban medical center. Similar proportions of patients were readmitted to the hospital following surgery — about 10% of lung cancer patients and 14% of colon cancer patients.

The study also highlighted the travel burden on rural patients seeking care at urban facilities. Colon cancer patients treated at urban hospitals traveled about 33 additional miles and 35 more minutes compared to those treated locally. Lung cancer patients at urban facilities traveled nearly 26 additional miles and 23 more minutes.

Researchers noted that long travel times and associated costs can be a significant burden for many cancer patients living in rural communities, and emphasized the importance of determining which patients can receive care locally versus those who may benefit from more centralized care.