Geographic Inequalities in Progress against Lung Cancer among Women in the United States, 1990-2015

Background: Lung cancer-related death rates in the United States have declined steadily since 1990 in men but not until the mid-2000s in women, with the gap in mortality narrowing during the most recent time period. We examined variation in the declining trend among women by county, where many tobacco control policies are implemented.Methods: We obtained county-level lung cancer death rates among women from the National Center for Health Statistics mortality file and calculated relative changes from 1990-1999 to 2006-2015. Optimized hotspot analysis identified contiguous counties with small declines or increases in death rates.Results: We identified two distinct clusters of counties: 669 in Appalachia and the Midwest (Hotspot 1) and 81 in the northern Midwest (Hotspot 2). From 1990-1999 to 2006-2015, death rates among women increased by 13% in Hotspot 1 and by 7% in Hotspot 2 counties, while rates decreased by 6% in the non-hotspot United States. From 1990-2015, death rate ratios (RRs) in hotspot versus non-hotspot counties changed from 4% lower (RR, 0.96; 95% CI, 0.94-0.99) to 28% higher [RR, 1.28; 95% confidence interval (CI), 1.25-1.31] for Hotspot 1 counties and from 18% lower (RR, 0.82; 95% CI, 0.76-0.89) to unity (RR, 0.99; 95% CI, 0.93-1.05) for Hotspot 2 counties.Conclusions: We identified areas in the Midwest and Appalachia where progress against lung cancer mortality among women has lagged compared with a steady national decline.Impact: Targeted tobacco control programs could reduce the excess burden of lung cancer among women living in hotspot counties and prevent widening geographic inequity. Cancer Epidemiol Biomarkers Prev; 27(11); 1261-4. ©2018 AACR.