Convergence of Cancer Mortality Rates Across U.S. States: The Role of Socioeconomic and Behavioral Risk Factors

Background Geographic disparities in U.S. cancer mortality rates raise concerns about whether different states are equally benefiting from advances in best practices for cancer prevention, early detection, and care. This study assesses whether U.S. states are catching up to the frontier of best practices while accounting for state-level differences in cancer risk factors.

We analyze age-adjusted cancer mortality rates across 48 U.S. states and evaluate their convergence over the period from 1997 to 2021. Specifically, we examine whether states with initially higher mortality rates have experienced steeper declines in those rates over time, both with and without adjusting for state-level differences in cancer-related risk factors. We also investigate whether risk factors themselves have converged over time.

There is little evidence of unconditional convergence in cancer mortality across U.S. states. However, when controlling for risk factors such as smoking, obesity, share of manufacturing employment, and per capita GDP, convergence becomes evident. Conditional on those risk factors being similar, if one state’s mortality rate is higher than another’s, then roughly half of the gap closes within 12 years. Persistent disparities in cancer-related risk factors largely explain the absence of unconditional convergence.

These findings suggest states are making progress in best practices for cancer care. However, to reduce the dispersion of state-level cancer mortality rates around the national average, it will be necessary to address enduring state-level disparities in socioeconomic and behavioral determinants of cancer mortality. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Data and replication files are available at: https://github.com/ACOlivei/US-States-Cancer-Mortality Revision to correct a misspelling in author's affiliation in the cover page. Data Availability Data and replications files are available at: https://github.com/ACOlivei/US-States-Cancer-Mortality.