Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural–urban differences in cancer incidence and trends.


We used the North American Association of Central Cancer Registries dataset to investigate rural–urban differences in 5-year age-adjusted cancer incidence (2015–2019) and trends (2000–2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEERStat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APC).


We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared with urban areas (447.9), with the largest rural–urban difference in the South (464.4 vs. 449.3). Rural populations also exhibited higher rates of tobacco-associated, human papillomavirus–associated, and colorectal cancers, including early-onset cancers. Tobacco-associated cancer incidence trends widened between rural and urban from 2000 to 2019, with significant, but varying, decreases in urban areas throughout the study period, whereas significant rural decreases only occurred between 2016 and 2019 (APC = −0.96). Human papillomavirus–associated cancer rates increased in both populations until recently with urban rates plateauing whereas rural rates continued to increase (e.g., APC = 1.56, 2002–2019).


Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared with urban populations. Improvements in these rates were typically slower in rural populations.


Our findings underscore the complex nature of rural–urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.

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