Differences in Cancer Mortality Trends between Metropolitan and Non-Metropolitan Areas in Japan, 1999–2018

Background: Although socioeconomic statuses affect cancer mortality rates, the specific difference between metropolitan and non-metropolitan areas in Japan has not been evaluated. This study analyzed differences in cancer mortality between metropolitan and non-metropolitan areas in Japan, using an age-period-cohort (APC) analysis. Methods: Data on cancer mortality from 1999 to 2018 for metropolitan and non-metropolitan areas in Japan were used. Here metropolitan areas were defined as government ordinance-designated municipalities in 1999 and special wards of Tokyo. In addition to general mortality data for all cancer sites, data on mortality for stomach, colorectal, liver, gallbladder, pancreatic, lung, prostate, and breast cancers were used for analysis. A Bayesian APC analysis was administered to the data for each type of cancer for area and for sex-distinguished data. Additionally, the ratios for estimated mortality rate by periods and cohorts between the two areas were calculated. Results: The age-standardized mortality rate for cancer in all sites in non-metropolitan areas was lower than that in metropolitan areas throughout the analyzed years for both men and women, but the mortality difference decreased during the periods for men. The rates of decrease in mortality rate in cohorts differed for some cancers between the two area types, and the mortality rate ratios of metropolitan compared with non-metropolitan areas decreased for cancer in all sites over the analyzed cohorts for men. Also, the rate of decrease in mortality rate over the cohorts was completely different between the areas for stomach cancer in men and for liver cancer for women. Conclusion: Mortality rates for cancer in all sites tended to diverge between the two area types in younger cohorts for men, and people in younger cohorts in non-metropolitan areas should take more extensive preventive measures against cancer than their counterparts in metropolitan areas.