Associations Between Household Income and Cancer History in U.S. Rural and Urban Adults

Purpose Rural populations in the United States experience disparities in cancer outcomes, but few studies have examined the joint influence of rural residence and household income on cancer prevalence. This study investigates the associations between rurality, household income, and self-reported cancer diagnosis among U.S. adults. Methods We analyzed weighted data from 229,354 adults participating in the 2019–2024 National Health Interview Survey (NHIS). Bivariate and multivariate logistic regression models were used to examine associations between household income, rurality, and cancer prevalence, adjusting for sociodemographic and health characteristics and health insurance coverage. Results In adjusted regression models, household income was significantly associated with cancer diagnosis ( P  < 0.001), while rurality was not. In stratified analyses, household income was inversely associated with cancer prevalence in both rural and urban populations, though associations were more consistent among urban areas. Conclusions Income was consistently significantly associated with cancer prevalence among urban but not rural adults, implying that other barriers may overshadow the influence of financial resources in rural populations. In urban areas, lower income was consistently associated with lower reported cancer prevalence, likely reflecting reduced access to diagnostic services among lower-income groups rather than true differences in disease burden. While income disparities shape cancer prevalence in urban settings, rural cancer disparities may be driven more by structural barriers to care.