Cancer
Rural-Urban Differences in the Age-Adjusted Pediatric Cancer Mortality in the United States Josiane Kabayundo* Josiane Kabayundo Reitumetse Setai Emma Hymel Krishtee Napit Abraham Mengist Don Coulter Jenna Allison Shinobu Watanabe-Galloway Kendra Ratnapradipa
Introduction: While there is evidence of decreasing pediatric cancer mortality rates in the United States, limited studies exist on rural-urban disparities of pediatric cancer mortality; in addition, there is a knowledge gap in understanding whether these disparities differ by race. This study aimed to: (1) examine rural-urban differences in age-adjusted pediatric cancer mortality rate during the period 2016-2020 in the United States; (2) examine the moderating effect of race on the impact of rurality on pediatric cancer mortality (3) determine the time trend of pediatric cancer mortality rate between 2000 and 2020. Methods: The Surveillance, Epidemiology, and End Results (SEER) 12 data (2000-2020) were used to estimate the age-adjusted mortality rates (per 1,000,000 population) among children aged 0-19. The primary exposure variable was rurality. Rural-urban continuum Codes (RUCC) were used to classify rural and urban areas. SEER*Stat was used to calculate age-adjusted pediatric cancer mortality rates using the U.S. 2000 standard population and Tiwari modifications. Rural-urban pediatric cancer mortality rate comparisons were made for all cancers combined. Stratified analysis was conducted to test the moderation effect of race on the relationship between rurality and pediatric cancer mortality rates. Joint point analysis was used to estimate the annual percent changes (APCs) in mortality rates by rurality and racial/ethnic status. Results: Overall, there was no significant difference in age-adjusted mortality rates between rural and urban areas. When stratified by race, among Blacks, the mortality rate was lower in rural compared to urban areas (11.2 vs. 26.6 per 100,000), and among Americans Indians, the rate was higher in rural compared to urban areas (33.4 vs. 12.2 per 100,000). The mortality rates decreased between 2000 and 2020 (APC=-1.84, P<0.05). Both rural and urban areas have experienced a significant pediatric cancer mortality decline, however, urban areas experienced a steeper decline, with an APC of -1.86% compared to -1.57% in rural areas. Among different racial groups, Whites show a significant decline (APC of -2.01%) from 2000-2020, compared to Blacks (APC=-1.51%). Conclusion: Despite the decrease in mortality rates in both urban and rural areas, there are still geographic and racial disparities. Targeted interventions that address mortality rates among pediatric cancer patients should be developed.