Lung Cancer Mortality by County, Race and/or Ethnicity, and Sex in the United States, 2000–2019

<b>Rationale:</b> Examining lung cancer mortality trends at the county level would better inform our understanding of racial, ethnic, and geographic differences in the United States. <b>Objectives:</b> To analyze lung cancer mortality trends by race and/or ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Latino, and White), sex, and county. <b>Methods:</b> Data from the National Vital Statistics System and National Center for Health Statistics (2000-2019) were used to estimate age-standardized lung cancer mortality in 3,110 counties, adjusted for misclassification. <b>Results:</b> From 2000 to 2019, lung cancer mortality decreased from 68.3 (95% uncertainty interval, 67.9-68.7) to 42.5 (42.3-42.8) deaths per 100,000. Males experienced a larger decrease (44.8%) than females (29.4%). Similar patterns were observed at the county level, with considerable geographic variation within and across racial and/or ethnic populations. In 2019, higher rates among Black and White populations were observed in the Mississippi River watershed and Appalachia and in AIAN populations in the upper Midwest, Northeast, North Carolina, Oklahoma, and Kansas. From 2000 to 2019, for males and females combined, lung cancer mortality rates increased in 57 counties (12.0%) for the AIAN population, with a median increase of 7.5 deaths per 100,000. Increases in counties were less common among Asian (<i>n</i> = 36, 5.4%), Latino (<i>n</i> = 36, 2.4%), and White (<i>n</i> = 1) populations, whereas no county showed an increase for Black individuals. <b>Conclusions:</b> Despite marked reductions in lung cancer mortality, geographic and racial and/or ethnic differences persist, which emphasizes the need for targeted interventions to further improve lung cancer outcomes for all populations.