State-level rurality and cigarette smoking-associated cancer incidence and mortality: Do individual-level trends translate to population-level outcomes?

PREVENTIVE MEDICINE

卷:152

Article

Villanti, Andrea C.^1,2  Klemperer, Elias M.¹  Sprague, Brian L.^2,3,4  Ahern, Thomas P.^2,3 

[1] Univ Vermont, Larner Coll Med, Vermont Ctr Behav & Hlth, Dept Psychiat, 1 South Prospect St,3rd Floor,MS 482, Burlington, VT 05405 USA

[2] Univ Vermont Canc Ctr, Canc Control & Populat Hlth Sci Program, Burlington, VT 05405 USA

[3] Univ Vermont, Larner Coll Med, Dept Surg, Div Surg Res, Burlington, VT 05405 USA

[4] Univ Vermont, Larner Coll Med, Off Hlth Promot Res, Burlington, VT 05405 USA

关键词: Tobacco;    Cancer;    Rural;    Disparities;   

DOI  :  10.1016/j.ypmed.2021.106759

来源: Elsevier

【 摘 要 】

County-level analyses demonstrate that overall cancer incidence is generally lower in rural areas, though incidence and mortality from tobacco-associated cancers are higher than in non-rural areas and have experienced slower declines over time. The goal of our study was to examine state-level rurality and smoking-related cancer outcomes. We used publicly-available national data to quantify rurality, cigarette smoking prevalence, and smoking-attributable cancer incidence and mortality at the state level and to estimate the population-attributable fraction of cancer deaths attributable to smoking for each state, overall and by gender, for 12 smoking-associated cancers. Accounting for a 15-year lag between smoking exposure and cancer diagnosis, the median proportion of smoking-attributable cancer deaths was 28.2% in Virginia (24.6% rural) and ranged from 19.9% in Utah (9.4% rural) to 35.1% in Kentucky (41.6% rural). By gender, the highest proportion of smoking-attributable cancer deaths for women (29.5%) was in a largely urban state (Nevada, 5.8% rural) and for men (38.0%) in a largely rural state (Kentucky). Regression analyses categorizing state-level rurality into low (0-13.9%), moderate (15.3-29.9%) and high (33.6-61.3%) levels showed that high rurality was associated with 5.8% higher cigarette smoking prevalence, higher age-adjusted smoking-associated cancer incidence (44.3 more cases per 100,000 population), higher smoking-associated cancer mortality (29.8 more deaths per 100,000 population), and 3.4% higher proportion of smoking-attributable cancer deaths compared with low rurality. Our findings highlight the magnitude of the relationship between state-level rurality and smoking-attributable cancer outcomes and the importance of tobacco control in reducing cancer disparities in rural populations.

【 授权许可】

Free