Deaths of Despair Among Cancer Survivors in Rural/Urban Appalachia (2000-2022)

Authors

• Jason Semprini, Des Moines UniversityFollow
• Anders Erickson, Des Moines UniversityFollow
• Nosa Osazuwa-Peters, Duke UniversityFollow

Corresponding Author

Jason Semprini: jsemprini@dmu.edu

Author Affiliations

Jason Semprini, PhD, MPP:  Department of Public Health, Des Moines University (Des Moines IA); E-mail: jsemprini@dmu.edu; ORCiD: https://orcid.org/0000-0002-0375-8090

Anders Erickson, MMSc: College of Medicine, Des Moines University

Nosayaba Osazuwa-Peters, PhD, MPH: School of Medicine, Duke University (Durham NC)

Author Area of Expertise

Cancer Epidemiology, Rural Health, Survivorship, Health Services Research

Abstract

Introduction: Rising deaths of despair (premature deaths from suicide, overdose, alcohol, and violence) in adults under age 65 persist across the United States, especially in Appalachia. People diagnosed with cancer may face elevated risks of such deaths due to pain, psychosocial distress, and financial hardship.

Purpose: Deaths of despair trends were compared among adults with cancer across Appalachian and non-Appalachian regions, stratified by sex and rurality.

Methods: Analyzing SEER-21 Incidence-Based Mortality data (2000–2022), deaths caused by suicide, cirrhosis of the liver, or accidents (includes overdose) were identified among adults aged 20–64 years. Annual mortality rates per 100,000 total population were stratified by sex (males, females), rurality (urban = RUCC 1-3; rural = RUCC 4–9), and Appalachian status (2008 definition). Average annual percentage changes (APCs) were estimated using log-linear regression with bootstrapped 95% confidence intervals (reps=9,999). Differences in APCs across regions and rurality were assessed via contrast tests using fixed-effects models that adjusted for year-specific shocks.

Results: In 2022, deaths of despair were highest in rural Appalachian males (7.3 per 100,000 males) and lowest among urban non-Appalachian females (1.9 per 100,000 females). Between 2000-2022, male deaths of despair increased annually by 8.8% in rural Appalachia. Female deaths of despair increased annually by 15.5% in urban Appalachia and 15.9% rural Appalachia.

Implications: Deaths of despair among cancer patients increased across all regions, with the steepest rises in Appalachia. Findings underscore the need for regionally targeted psychosocial and substance use support within cancer survivorship programs.

DOI

https://doi.org/10.13023/jah.0802.02

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Semprini J, Erickson A, Osazuwa-Peters N. Deaths of despair among cancer survivors in rural/urban Appalachia (2000-2022). J Appalach Health 2026; 8(2):14-28. DOI: https://doi.org/10.13023/jah.0802.02