CRC Mortality Declined Nationally, but Sharp County Disparities Remain

National colorectal cancer (CRC) mortality declined substantially from 2000 to 2019 across racial and ethnic groups, but county-level disparities remained pronounced in 2019, with mortality rates varying by more than 15-fold among some populations, according to a study published in JAMA Oncology.¹

“In the past 2 decades, substantial declines in national CRC mortality rates have been observed in the US; however, it is unclear whether these improvements have happened ubiquitously across geography, race and ethnicity, sex, and age group,” the researchers wrote.

The cross-sectional study, conducted by the Global Burden of Disease US Health Disparities Collaborators, used small-area estimation models to calculate county-level CRC mortality rates by race and ethnicity, sex, and age group (younger than 45 years and 45 years or older) across 3110 US counties or combined county units from 2000 to 2019. Estimates were based on National Vital Statistics System death records and incorporated corrections for race and ethnicity misclassification on death certificates. The analysis covered 5 racial and ethnic groups: American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White.

National Declines Mask Persistent Local Disparities

Among adults aged 45 years or older, CRC mortality declined nationally between 2000 and 2019. Among men, the rate fell from 82.5 deaths per 100,000 population (95% uncertainty interval [UI], 81.7-83.2) to 54.4 deaths per 100,000 (95% UI, 53.9-54.9). Among women, mortality declined from 58.9 deaths per 100,000 (95% UI, 58.4-59.3) to 39.7 deaths per 100,000 (95% UI, 39.4-40.0).

Despite these national improvements, considerable county-level variation remained in 2019, including among counties within the same states. The largest variation was observed among American Indian or Alaska Native males aged 45 years or older, whose county-level CRC mortality rates ranged from 13.6 deaths per 100,000 (95% UI, 8.2-20.8) to 213.5 deaths per 100,000 (95% UI, 147.1-309.0).

Overall, 275 counties with unmasked estimates had CRC mortality rates exceeding 100 deaths per 100,000 among at least 1 population aged 45 years or older. These included 13 counties among American Indian or Alaska Native females, 92 among American Indian or Alaska Native males, 182 among Black males, 1 among Hispanic or Latino males, and 4 among White males. No other populations had counties exceeding 100 deaths per 100,000.

The findings demonstrate that national improvements in CRC mortality did not occur uniformly across geographic areas or populations. In some counties, mortality remained substantially higher than the national average, particularly among American Indian or Alaska Native and Black populations.

Younger Adults Show a Different Pattern

The mortality pattern differed among adults younger than 45 years. Rather than experiencing the declines observed among older adults, CRC mortality rates were stable or increased from 2000 to 2019. This finding adds to growing concerns about CRC among younger adults, for whom increasing incidence and mortality have emerged despite continued improvements in CRC outcomes among older populations.

These findings are consistent with the American Cancer Society's 2026 CRC statistics report, which found that American Indian or Alaska Native individuals have the highest CRC incidence and mortality rates nationally, followed by Black individuals.² The report also highlighted persistent racial and ethnic disparities in CRC outcomes and noted that overall mortality has recently stabilized, driven in part by increasing mortality among younger adults.

Implications for Health Care and Public Health

The county-level variation identified in the study highlights the limitations of relying solely on national or state-level CRC mortality statistics.¹ Geographic disparities may be obscured when population-level trends are aggregated across counties and racial and ethnic populations.

“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,” the researchers wrote. “However, CRC mortality rates remain extremely high in some counties and populations. These findings can help inform targeted intervention strategies for communities at highest risk.”

References

1. 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
2. Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067