There are a number of technical and statistical problems in monitoring the temporal and spatial variation of local area death rates in the United States for evidence of systematically elevated risks. An analytic strategy is proposed to reduce one of the major statistical concerns, i.e., that of identifying areas with truly elevated mortality risks from a large number of local area comparisons. This analytic strategy involves two stages. The first is a procedure for examining the entire distribution of local area death rates instead of simply selecting high risk 'outliers.' The second is the development of an analytic procedure to relate the temporal changes in the cross-sectional distribution of local area death rates to models of the disease process operating within the populations in those areas. The procedures are applied to data on cancer mortality for the 3050 counties (or county equivalents) of the United States over the period 1950 to 1978. A number of striking mort ality patterns, both within the entire United States and within various regions and states, are identified.