Regional Disparities Persist Despite National Declines in Lung Cancer Mortality Rates

Lung cancer mortality has fallen substantially across the United States since 1999, but deep regional, gender, racial, and state-level disparities persist despite overall progress, according to a study published in Respiratory Research.

“Previous research has predominantly emphasized demographic data, leaving a notable gap in the literature regarding regional and geographic variations,” explained Taylor Billion, Creighton University School of Medicine in Omaha, NE, and coauthors.

The researchers used the Center for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to obtain data on lung cancer mortality in people ages 25 years and older. From 1999–2022, 3 895 299 US deaths were attributed to lung cancer. The national age-adjusted mortality rate (AAMR) declined from 91.4 per 100 000 in 1999 to 52.0 in 2022 (average annual percent change [AAPC] −2.44%, 95% CI −2.51 to −2.36), with the fastest declines in 2013–2019 (APC −4.14%) and a slower decrease in 2019–2022 (APC −2.02%). Regionally, the West consistently had the lowest mortality (AAMR 80.32 to 40.15; AAPC −2.95%), while the Midwest and South carried the highest burdens by the end of the period. The South AAMR fell from 99.31 to 56.73 (AAPC −2.43%), and the Midwest from 93.55 to 59.50 (AAPC −1.93%). The Northeast dropped from 86.55 to 48.02 (AAPC −2.62%).

By gender, men experienced larger absolute declines but higher mortality throughout. The AAMR for men decreased from 127.3 to 61.2 (AAPC −3.13%), and female AAMR from 66.0 to 44.9 (AAPC −1.65%), with a notable acceleration in reductions for both sexes through 2019, followed by slower improvement thereafter. Within regions, Southern and Midwestern men alternated as the highest-risk groups, whereas Western men and women maintained the lowest AAMRs. Racially, Non-Hispanic (NH) White AAMR declined from 94.42 to 57.28 (AAPC −2.12%); NH Black from 107.44 to 55.44 (AAPC −2.83%); NH American Indian/Alaska Native from 65.30 to 43.19 (AAPC −1.69%); and Hispanic/Latino from 40.85 to 24.85 (AAPC −2.20%). Despite broad declines, Midwestern NH Black populations and Southern NH White populations showed persistently elevated mortality compared with peers, though all groups improved over time.

From 1999–2019, every state’s AAMR fell, led by Delaware (−53.4), Nevada (−49.2), and Maryland (−48.0), while North Dakota (−13.2), Utah (−17.8), and Hawaii (−18.0) had the smallest drops. In 2019–2021, Nevada again led declines (−9.03), with 14 states showing increases, the largest in Alaska (+6.48), West Virginia (+4.30), and Arizona (+3.00). Incidence trends mirrored mortality, with the national age-adjusted incidence rate falling from 109.3 per 100,000 in 1999 to 72.8 in 2020 (AAPC −1.79%), with declines accelerating in 2018–2020 (APC −7.06%).

“Understanding these variations is essential for healthcare professionals and researchers to track their efforts in reducing lung cancer-related deaths and identifying high-risk populations,” concluded the study authors.

Reference

Billion T, Verheyen L, Abdul Jabbar AB, et al. Regional trends and disparities of lung cancer mortality in the United States, 1999-2022: a retrospective cohort study. Respir Res. 2025;26(1):280. doi:10.1186/s12931-025-03344-0