Rural–Urban and Racial/Ethnic Disparities in Invasive Cervical Cancer Incidence in the United States, 2010–2014

Abstract

Introduction Racial and socioeconomic disparities exist in cervical cancer screening, incidence, and mortality. The purpose of this study was to investigate how cervical cancer stage at diagnosis is associated with rurality and race/ethnicity. Methods We analyzed 2010 through 2014 data from the Centers for Disease Control and Prevention’s National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. We compared cervical cancer frequency and age-adjusted incidence for each stage by county-level rurality and race/ethnicity. Results There were 59,432 incident cases of cervical cancer reported from 2010 through 2014. The most common stage at diagnosis was localized (urban, 43.3%; rural 41.3%). Rural counties had higher incidence than urban counties for localized (rate ratio [RR] = 1.11; 95% confidence interval [CI], 1.07–1.15), regional (RR = 1.14; 95% CI, 1.10–1.19), and distant (RR = 1.12; 95% CI, 1.05–1.19) stage cervical cancer. Hispanic and non-Hispanic black women had higher incidence of regional and distant cervical cancer than non-Hispanic white women. Non-Hispanic white women in rural counties had higher incidence than those in urban counties at every stage. However, incidence for non-Hispanic white women was lower than for non-Hispanic black or Hispanic women. Conclusion Rural counties had higher incidence of cervical cancer than urban counties at every stage. However, the association of rural residence with incidence varied by race/ethnicity.

Factors associated with not receiving HPV vaccine among adolescents by metropolitan statistical area status, United States, National Immunization Survey–Teen, 2016–2017

“…6 Similarly, a more recent analysis examined cervical cancer stage at diagnosis by urban-rural status. 7 Authors noted higher incidence of cervical cancer in rural counties at every stage, when compared to urban counties. 7 Several factors may contribute to the increased disease burden in rural areas, including a lack of primary care providers and a lack of provider recommendations for screening and preventive care services.…”

“…7 Authors noted higher incidence of cervical cancer in rural counties at every stage, when compared to urban counties. 7 Several factors may contribute to the increased disease burden in rural areas, including a lack of primary care providers and a lack of provider recommendations for screening and preventive care services. [8][9][10] Regarding HPV vaccination as a specific preventive measure, barriers in rural areas may include financial and/or access-related limitations in addition to lack of provider recommendation for vaccination.…”

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

“…One of every 3 persons is expected to be diagnosed as having cancer in his or her lifetime, 1,2 with cancer ranking as the second leading cause of death in the United States. 3 Although cancer-related mortality has declined over the past few decades, substantial racial/ethnic, 4,5 rural, 4,6 educational attainment, 5,7 and socioeconomic 7,8 disparities remain. 9 Breast, cervical, and colorectal cancers are among the most frequently diagnosed cancers in the United States, and breast cancer and colorectal cancer are the second and fourth most prevalent causes of cancer-related deaths.…”

“…6 Addressing social determinants of health and ameliorating disparities in underserved populations are a priority, made increasingly more urgent and feasible as health systems shift toward value-based care models and a more holistic view of patients and population health. 15 The social determinants of health framework hypothesizes that social and economic conditions shape population health, with the following 5 constructs associated with health outcomes: (1) economic stability, (2) educational level, (3) neighborhood and built environment, (4) health and health care, and (5) social and community context. 16 However, prior studies examining disparities in cancer screening practices have not considered all aspects of this framework, instead focusing on select components that may not capture the full complexity of a patient's situation.…”

The Extended Stability of Cervical Swabs in careHPV™ Collection Medium

“…It was estimated that more than 80% of cervical cancer incidences were from lowand medium-income countries (LMIC) that lack organised screening and HPV vaccination programmes (2). There is also a signi cant disparity between the urban and the rural populations (3,4), mainly due to the inaccessibility of proper healthcare facilities, poverty and other cofactors (5).…”