In 1991, cancer mortality rates in the United States underwent a major shift, and for the first time, deaths began to decline steadily, a trend that continues to this day. Researchers at the Mississippi Social Science Research Center, in collaboration with scientists at Oak Ridge National Laboratory, investigated this decline to determine where and who benefited most from this dramatic improvement.
A recent article published in the British Journal of Cancer by MSU SSRC Giles Emeritus Professor Arthur G. Cosby and a team of researchers analyzed cancer deaths in nearly 3,000 U.S. counties from 1981 to 2019 and found that urban areas and wealthier counties were more likely to have significantly lower cancer death rates. This article is available at www.nature.com/articles/s41416-026-03339-8?
The dramatic decline in cancer deaths has occurred very unevenly across the United States, and many Americans do not share in this important improvement in the nation’s health. Identifying locational differences in cancer decline can provide insight into factors limiting improvements in cancer health at the community level. ”
Arthur G. Cosby, MSU SSRC Giles Professor Emeritus
The article “Who Benefits from the Dramatic Decline in U.S. Cancer Mortality Rates?: Place-Based Evidence on Disparities in Improvement Rates” examines the forces and characteristics that contribute to these differences in mortality decline. When cancer rates peaked in 1991, there was initially little difference between the highest and lowest income counties. By 2019, the 10% of people living in the highest-income counties had about a seven-fold improvement in mortality rates compared to the 10% of people living in the lowest-income counties.
“Location can make a big difference in health outcomes, and this was certainly the case for county cancer mortality rates. Geographical differences were clear,” Cosby said. “Metropolitan centers on both the Atlantic and Pacific coasts consistently had the highest rates of cancer improvement. At the same time, rural areas and small cities in the interior of the United States often had much lower rates of cancer improvement.”
The study used death certificates from more than 23 million cancer deaths collected by the Centers for Disease Control and Prevention. This period was chosen to capture the transition period: an earlier period of increasing mortality, a peak transition point in 1991, and the current period of decreasing cancer mortality.
Cosby said health researchers attribute the decline in cancer mortality to a significant range of health interventions. These include preventative measures and improvements in cancer treatment. He said, for example, county differences in cancer improvement are likely the result of differences in the use and acceptance level of health practices in counties, citing, for example, reductions in tobacco use brought about by health warnings, increased taxes on cigarettes, and smoke-free laws.
“New York City, a wealthy metropolis, has been aggressive in implementing tobacco control measures, and the results show it. In 1991, the lung cancer rate in the borough of Manhattan was 49 per 100,000 people. By 2019, the lung cancer rate had fallen to 19.6, a 60% decrease,” Cosby said.
Cosby led the study with Viswadeep Revakula, principal scientist of the LandScan Global Project at Oak Ridge National Laboratory, and Gina Mendez Rico, SSRC research assistant professor. Other authors are Carissa Bergine, assistant director of research operations at George Mason University’s Center for Resilient and Sustainable Communities; Mackenzie Bumgarner, former SSRC Undergraduate Research Assistant; and Alina Peluso, a researcher at Oak Ridge National Laboratory.
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Reference magazines:
Cosby, A.G.; Others. (2026). Who is benefiting from the dramatic decline in U.S. cancer mortality? Place-based evidence showing disparities in improvement rates. British Cancer Journal. DOI: 10.1038/s41416-026-03339-8. https://www.nature.com/articles/s41416-026-03339-8?
