Ross K, et al. - Researchers sought to determine the geographic variation in the declining trend of lung cancer–related death rates among women in the United States. They carried out a county-level investigation including countries where many tobacco control policies are implemented. Relative to a steady national decline, the areas in the Midwest and Appalachia where progress against lung cancer mortality among women has lagged were identified. In these regions, the excess burden of lung cancer among women could be attenuated via targeted tobacco control programs and widening geographic inequity could be prevented.

• Using the National Center for Health Statistics mortality file , researchers obtained county-level lung cancer death rates among women and calculated relative changes from 1990–1999 to 2006–2015.
• Contiguous counties with small declines or increases in death rates were also identified via optimized hotspot analysis.

• Two distinct clusters of counties were identified: 669 in Appalachia and the Midwest (Hotspot 1) and 81 in the northern Midwest (Hotspot 2).
• In Hotspot 1 and in Hotspot 2 counties, death rates among women increased by 13% and by 7%, respectively, from 1990–1999 to 2006–2015.
• During this time period, rates decreased by 6% in the non-hotspot United States.
• In hotspot vs non-hotspot counties, death rate ratios (RRs) changed from 4% lower (RR, 0.96; 95% CI, 0.94–0.99) to 28% higher [RR, 1.28; 95% confidence interval (CI), 1.25–1.31] for Hotspot 1 counties and from 18% lower (RR, 0.82; 95% CI, 0.76–0.89) to unity (RR, 0.99; 95% CI, 0.93–1.05) for Hotspot 2 counties, from 1990–2015.