Pediatric and Adolescent Cancer Incidence Rates in 29 Non‐Metropolitan US Counties: An Analysis of Publicly Available Data

BACKGROUND: Geographic disparities in pediatric and adolescent cancer incidence are poorly characterized in the United States, partly due to suppression of data for small populations. This study describes pediatric cancer incidence rates in and county characteristics of rural counties with publicly available data. METHODS: We conducted a descriptive study using publicly available age-adjusted all-site pediatric cancer incidence rates per 100,000 children (0-19 years) from NCI's State Cancer Profiles (5-year estimates, 2018-2022) combined with county-level sociodemographic characteristics from County Health Rankings (2022). N = 29 non-metropolitan counties (∼2% of rural counties) had publicly available data for analysis. Descriptive statistics summarized incidence rates and county characteristics. RESULTS: Median pediatric cancer incidence in the sample was 23.9 per 100,000 (range: 11.2-39.6). Sample counties had the following medians: population of 105,851; 86.2% non-Hispanic White; 20.8% under 18; 16% child poverty; a $1787 school funding gap; and 51% of children enrolled in free/reduced-price lunch programs. Median primary care physician ratio was 1885:1, and median all-cause child mortality was 48.9 per 100,000. Counties were distributed across all four US Census regions (8 = Northeast, 7 = Midwest, 7 = South, 6 = West). Incidence rates were generally higher in the Northeast and parts of the South, and lower in the West and select Midwest counties, illustrating substantial heterogeneity across the sample rural counties. CONCLUSIONS: Despite a non-representative sample, these data provide one of the only recent descriptions of pediatric cancer incidence in rural US counties, highlighting regional variability and the limitations of publicly available surveillance data for pediatric cancers in rural areas.