Rural adults have more pessimistic and fatalistic views about their risks of contracting and dying from cancer, according to a new survey conducted by Mayo Clinic.

The rural-urban divide transcended differences in age, race and health insurance, according to the survey of 1,157 people in Mayo’s three primary service areas, Arizona, Florida and Rochester, Minn.

The difference could help explain why preventable cancers haven’t been declining as quickly in rural areas, said Kristin Harden, the lead researcher, who presented the findings at a public health conference in Washington, D.C.

“Having these kinds of pessimistic beliefs toward cancer prevention may discourage participation in cancer prevention and screening, which could contribute to health disparities,” she said.

The share of people extremely or moderately worried about getting cancer ranged from 37 percent among rural respondents to 23 percent among those in urban areas.

Rural respondents also were more likely to agree with survey statements such as, “There is not much you can do to lower your chances of getting cancer,” and “There are so many different recommendations about preventing cancer, it’s hard to know which ones to follow.”

Harden said health care providers and researchers need to understand these differences in outlook. If certain people feel an inevitability about cancer, they might resist recommendations such as quitting smoking — a leading risk for lung cancer, she noted.

Minnesota generally has higher incidence rates of cancers but lower death rates, according to the American Cancer Society’s 2019 facts and figures report. There are exceptions; incidence and death rates from non-Hodgkin’s lymphoma are both higher in the state.

But declines in cancer deaths have not been uniform, according to data from the U.S. Centers for Disease Control and Prevention. The rate of cancer deaths in urban Hennepin and Ramsey counties, for example, has declined from 180 per 100,000 people in 1990 to 158 in 2017, according to the CDC data. But the comparable cancer death rates in Minnesota’s “noncore” rural areas were 243 and 254 for those years, respectively.