North Dakota is a rural state with high rates of cancer. Determining how various demographic, geographic, and funding factors contributed to cancer incidence on a state and county level helps improve cancer prevention and control.
We examined cancer incidence rate trends by demographic (sex and ethnicity) and geographic (county, population, rural/frontier status) factors. We also examined cancer funding and research output by year.
Cancer incidence rates were obtained from the North Dakota Cancer Registry and stratified by sex, ethnicity, and county. US cancer rates also were obtained for comparison. Generalized linear models were used to compare overall incidence rates and yearly trends.
Male melanoma incidence rates increased faster than the US average across year P = 0.020). Incidence rates for prostate, lung, and colorectal cancer among American Indians/Alaska Natives (AI/AN) decreased faster than Whites across year (  < 0.001, = 0.001,  < 0.001, respectively). Four counties-2 for breast cancer and 2 for prostate cancer-had differential trends compared to the North Dakota average across year ( = 0.011,  = 0.029; = 0.046,  = 0.042). County-level lung cancer incidence rates were positively correlated with county population size, while rates for cervix/uteri were negatively correlated ( = 0.001,  = 0.023). Funding from the National Institutes of Health for North Dakota increased across year along with cancer papers published increased ( < 0.001,  < 0.001).
Examining state and county data revealed several surprising trends and the need for a more fine-scale approach to cancer cause, control, and prevention.

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