County-Level Analysis Reveals Persistent Racial and Ethnic Disparities in Colorectal Cancer Mortality
Key Clinical Summary
US Colorectal Cancer Mortality Disparities Persist
- This population-based cross-sectional study modeled county-level colorectal cancer (CRC) mortality from 2000–2019 across 3,110 US county units, representing a mean annual population of approximately 306 million.
- Among adults aged ≥45 years, mortality fell from 82.5 to 54.4 deaths per 100,000 in males and 58.9 to 39.7 in females; Black males remained highest in 2019 at 76.1 per 100,000.
- Mortality exceeded 100 per 100,000 in at least 1 population in 275 counties. Rates among adults <45 years were generally stable or increasing; the cross-sectional study could not establish causes, but findings may inform targeted interventions.
Despite substantial national declines in colorectal cancer (CRC) mortality over the past 2 decades, marked geographic and racial and ethnic disparities persist across US counties, particularly among adults aged 45 years or older.
In this population-based cross-sectional study, investigators used validated small-area estimation models to assess county-level CRC mortality from 2000 to 2019 across race and ethnicity, sex, and age groups. The analysis included 3110 counties or combined county units, representing a mean annual population of approximately 306 million individuals.
Among adults aged 45 years or older, CRC mortality declined nationally from 82.5 to 54.4 deaths per 100,000 population among males and from 58.9 to 39.7 deaths per 100,000 among females. Declines were observed across all racial and ethnic groups, with the largest absolute decreases occurring among Black males and females. However, Black males aged 45 years or older continued to have the highest CRC mortality rate in 2019 at 76.1 deaths per 100,000 population, followed by American Indian or Alaska Native males at 67.6 per 100,000.
County-level variation was substantial. Among American Indian or Alaska Native males aged 45 years or older, mortality rates ranged from 13.6 to 213.5 deaths per 100,000 population. Overall, 275 counties had CRC mortality rates exceeding 100 deaths per 100,000 among at least 1 racial and ethnic and sex population. These included 182 counties among Black males, 92 among American Indian or Alaska Native males, and 13 among American Indian or Alaska Native females.
Most counties experienced mortality declines among adults aged 45 years or older between 2000 and 2019. In contrast, trends among individuals younger than 45 years were less favorable. National CRC mortality rates in this age group were substantially lower but generally remained stable or increased, and most counties showed absolute increases across several racial and ethnic and sex groups.
The investigators noted that persistent disparities may reflect differences in screening, access to cancer care, socioeconomic conditions, and other population-level factors, while emphasizing that the study was not designed to establish causal mechanisms.
“This cross-sectional study found significant improvements in CRC mortality in adults aged 45 years or older at the national level and across all racial and ethnic populations between 2000 and 2019. However, CRC mortality rates remain extremely high in some counties and populations,” the study authors concluded. “These findings can help inform targeted intervention strategies for communities at highest risk.”
Reference
GBD US Health Disparities Collaborators. Racial and ethnic disparities in US colorectal cancer mortality by county, sex, and age. JAMA Oncol. Published online August 20, 2026. doi:10.1001/jamaoncol.2026.3194.
