{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:45:20Z","timestamp":1792079120175,"version":"4.4.0"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec id=\"ab-coi260048-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>In the past 2 decades, substantial declines in national colorectal cancer (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess variation in CRC mortality rates and changes over time, across county, race and ethnicity, sex, and age group (&amp;amp;lt;45 years and \u226545 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This US population\u2013based cross-sectional study used validated small-area estimation models to estimate county-level CRC mortality rates by race and ethnicity, sex, and age group from 2000 to 2019. Data analysis was completed in May 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Estimates were stratified by county, race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White), sex (female and male), and age group (&amp;amp;lt;45 years and \u226545 years) as reported on death certificates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The outcome of interest was CRC mortality rates per 100\u202f000 individuals. Estimates were corrected for race and ethnicity misclassification on death certificates and age standardized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3110 counties or combined county units with data from 2000 to 2019 (mean annual population, 306 million), most counties saw declines in CRC mortality among adults aged 45 years or older, from 82.5 (95% uncertainty interval [UI], 81.7 to 83.2) to 54.4 (95% UI, 53.9 to 54.9) deaths per 100\u202f000 population among males and from 58.9 (95% UI, 58.4 to 59.3) to 39.7 (95% UI, 39.4 to 40.0) per 100\u202f000 deaths among females 45 years or older. However, in 2019, considerable county-level variation, including within states, was observed. The largest county-level variation was observed among American Indian or Alaska Native males aged 45 years or older, ranging from 13.6 (95% UI, 8.2-20.8) to 213.5 (95% UI, 147.1-309.0) deaths per 100\u202f000 population. Overall, 275 counties with unmasked estimates had CRC mortality rates of more than 100 deaths per 100\u202f000 among at least 1 population (American Indian or Alaska Native females: 13 counties; American Indian or Alaska Native males: 92 counties; Black males: 182 counties; Hispanic or Latino males: 1 county; White males: 4 counties; all other populations: 0). CRC mortality rates among individuals aged younger than 45 years were stable or increased from 2000 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-coi260048-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>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. These findings can help inform targeted intervention strategies for communities at highest risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoncol.2026.3194","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:01:19Z","timestamp":1787238079000},"page":"1135","source":"Crossref","is-referenced-by-count":0,"title":["Racial and Ethnic Disparities in US Colorectal Cancer Mortality by County, Sex, and Age"],"prefix":"10.1001","volume":"12","author":[{"name":"GBD US Health Disparities Collaborators","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula D.","family":"Strassle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Maryland, College Park"},{"name":"Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian S.","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Dwyer-Lindgren","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"},{"name":"Department of Health Metrics Sciences, University of Washington, Seattle,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dillon O.","family":"Sylte","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Montalvo-Clavijo","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"},{"name":"Department of Health Metrics Sciences, University of Washington, Seattle,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yekaterina O.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuochen","family":"Li","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa A.","family":"McHugh","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wichada","family":"La Motte-Kerr","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farah","family":"Daoud","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Force","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle"},{"name":"Department of Health Metrics Sciences, University of Washington, Seattle,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Mensah","sequence":"additional","affiliation":[{"name":"Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M.","family":"George","sequence":"additional","affiliation":[{"name":"Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda S.","family":"Hinerman","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin","family":"Choi","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J. 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