Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999–2009

Background The American Cancer Society estimates that about 25% of all US cancer deaths will be due to lung cancer – more than from cancers of the colon, breast, and prostate combined. Methods We ascertained county-level age-adjusted and age-specific death rates and 95% confidence intervals from the Centers for Disease Control and Prevention Compressed Mortality File. Multiple regression analyses were used to estimate the strength and direction of relationships between county poverty, smoking, fine particulate matter (PM2.5) air pollution, and US Census divisions and race- and sex-specific lung cancer deaths. Results Poverty, smoking, and particulate matter air pollution were positively and significantly related to lung cancer deaths among white men, but of these, only poverty and smoking were significantly associated with lung cancer deaths among white women. Residence in the South Atlantic, East South Central, and West South Central US Census divisions at the time of death was significantly associated with lung cancer deaths for both white men and white women. As with white men, poverty and smoking were associated with lung cancer deaths among black men, but of these, only adult smoking had a statistically significant association among black women. Conclusions The results support the need for further research, particularly in high-risk areas, to better differentiate factors specific to race and sex and to understand the impact of local risk factors

Rural congestive heart failure mortality among US elderly, 1999–2013: Identifying counties with promising outcomes and opportunities for implementation research

Objective Describe modern trends in congestive heart failure (CHF) among elderly (\u3e65 years of age) in the United States, to identify potentially successful rural areas. Compare CHF mortality using multiple- (MCOD) versus underlying-(UCOD) cause of death data. Methods U.S. Centers for Disease Control and Prevention mortality files (WONDER internet site). Results Using MCOD data, overall mortality rates/100,000 population (and 95% confidence intervals) for CHF among persons \u3e65 years of age (1999–2013) were 482.0 (481.2–482.8) for large central and large fringe metropolitan (LCLF) counties, 549.6 (548.6–550.7) in small and medium metropolitan (SM) counties, and 652.6 (650.9–654.0) in micropolitan and non-core, non-metropolitan (MNCNM) counties. Twenty positive deviance NCNM counties (collectively including 198,581 residents \u3e65 years of age) had an overall CHF rate of 300.9 (275.0–326.9) in 2013. This was significantly lower than the LCLF rate for 2013 (482.0 [481.2–482.8]), and represented a reduction of 47% since 1999. Overall CHF occurrence as estimated with MCOD was 3.4-fold higher than that obtained with UCOD. Conclusion These data illustrate underestimation of CHF by UCOD data and the importance of correct death certification. Rural CHF mortality rates are higher than urban rates, but some positive deviance counties demonstrate that this is not inevitable. Further research is needed to understand the relative contribution of research innovation, medical care, and public health to rural-urban disparities and the relative success of positive deviance counties