Cancer-related deaths in the US have steadily declined over the last 25 years after peaking in 1991 – but not equally across all income levels. America’s poorest populations are disproportionately suffering from some of the most preventable cancers and will continue to do so in 2019, according to new numbers published by the American Cancer Society.

“Although the racial gap in cancer mortality is slowly narrowing, socioeconomic inequalities are widening, with the most notable gaps for the most preventable cancers,” wrote researchers in CA: A Cancer Journal for Clinicians. Compared with more affluent counties, mortality rates in the poorest are double for cervical cancer and 40 percent higher for lung and liver cancers in men between 2012 and 2016.

Nearly three-quarters of these cases are “potentially preventable”, due to risk factors like obesity, cigarette smoking, excess alcohol consumption, and hepatitis B and C viruses. Those who live in poorer counties have double the rates of smoking and obesity paired with lower cancer screening and later stage diagnoses. This results in a 20 percent higher mortality rate than better-off counties during that same timeframe. Across the board death rates rose for cancers of the liver, pancreas, and uterine corpus, as well as those of the brain and other nervous system, soft tissue (including heart), and oral cavity and pharynx sites associated with the human papillomavirus (HPV), which is “rising faster than that for any other cancer in both men and women.”

But it’s not all bad. Researchers report major declines in lung, breast, prostate, and colorectal cancer, with lung cancer rates nearly halving between 1990 and 2016 among men and down by 23 percent in women from 2002 to 2016. Meanwhile, the death rate for breast cancer in women has dropped by 40 percent, while prostate and colorectal cancer have also more than halved. Between 1991 and 2016, cancer death rates have dropped 27 percent across the country, with 2.6 million fewer deaths during that timeframe. This year, estimates suggest more than 1.7 million new cancer cases diagnosed and just over 600,000 deaths. These numbers have to do with steady reductions in smoking and advanced early diagnosis.

Around one in three people will be diagnosed with some form of cancer. For American adults, cancer is the second-leading cause of death in the US after heart disease and the second-most common in children aged 1 to 14 (after accidents). This year, an estimated 11,060 children diagnosed with cancer will die from it, with leukemia accounting for almost one-third, followed by brain and other nervous system tumors.

What can we do? Researchers say health officials should apply existing cancer knowledge “with an emphasis on disadvantaged groups” in order to protect those disproportionately affected by preventable cancers.