Lung cancer disparities in rural, persistent poverty counties: a secondary data analysis

Background: In the US, lung cancer burden is greater in counties that are either rural or in persistent poverty. This study examined lung cancer risk (e.g., smoking), incidence, and mortality across four county types defined by cross-classification of rurality and persistent poverty. Methods: We conducted a secondary analysis of county characteristics and lung cancer risk, incidence and mortality. We used data from USDA to classify counties according to rurality (using rural–urban continuum codes) and persistent poverty (i.e., 20% + of residents living below the poverty line for 30 + years). We used publicly-available data to calculate mean county-level prevalence of smoking among adults (in 2019), lung cancer incidence (2015–2019), and lung cancer mortality (2015–2019) across county types. Beta and binomial regression models assessed differences in smoking, lung cancer incidence, and lung cancer mortality by rurality and persistent poverty. Results: Among U.S. counties, 1,115 were urban, non-persistent poverty, 1,675 were rural, non-persistent poverty, 52 were urban, persistent poverty, and 301 were rural, persistent poverty. Smoking, lung cancer incidence, and lung cancer mortality were higher in rural counties and in persistent poverty counties than in their comparison counties. Counties that were both rural and persistent poverty had the highest rates of smoking, lung cancer incidence, and lung cancer mortality. Persistent poverty and rurality interacted in their relationship with smoking prevalence (p < 0.01), and lung cancer mortality (p < 0.10). Conclusions: Smoking, lung cancer incidence, and lung cancer mortality are highest in counties that are both rural and persistent poverty, suggesting an urgent need to develop targeted lung cancer interventions in these communities.