Introduction: Cancer mortality is steadily rising in rural communities in the United States compared to urban counterparts. The underlying causes of these disparities are complex and multifactorial. Our objective was to describe trends in rural and urban incidence and mortality of genitourinary (GU) cancers in the Pennsylvania Cancer Registry. Methods: We conducted a retrospective review of age-adjusted incidence and mortality rates of GU (prostate (PC), bladder (BC), and kidney (KC)) cancers by county from 1990-2019. Counties were designated as urban or rural using the Center for Rural Pennsylvania’s population-density based definition defined as 284 people per square mile using 2019 county census data. In Pennsylvania, 48 rural counties and 19 urban counties were identified. Joinpoint regression was used to model average annual percent changes (AAPC) in age-adjusted incidence and mortality rates in urban and rural counties. Results: From 1990-2019, overall age-adjusted GU cancer incidence significantly decreased in rural (AAPC -7.5%, p=0.04) and in urban counties (-6.6%, p=0.02). For PC, age-adjusted incidence decreased in rural counties by -10.5% (p=0.02) and in urban counties by -9.1% (p=0.01). Age-adjusted incidence of BC was unchanged for both urban and rural counties. KC incidence increased in both rural counties (AAPC= +11.2, p=0.002) and in urban counties (AAPC= +9.3%, p=0.01). Overall GU cancer age-adjusted mortality decreased in rural counties (AAPC= -11.6, p=0.047) and in urban counties (AAPC -12.2, p=0.01). PC mortality for rural and urban counties decreased at similar rates (AAPC -15.5, p=0.03 and -15.4, p=0.02, respectively). Age-adjusted mortality for BC was unchanged for rural and urban counties over the study period. KC mortality in urban counties decreased (AAPC -6.9% p=0.03), while mortality in rural counties remained stable. Conclusions: From 1990-2019, overall GU cancer incidence and mortality have decreased in both rural and urban Pennsylvania counties. Across all counties, PC incidence and mortality have decreased, and BC incidence and mortality have remained stable. KC incidence increased across all counties; however, mortality remained stable in rural counties. These data may inform targeted interventions to improve outcomes for specific GU cancers in rural areas. SOURCE OF Funding: N/A
