Sociodemographic disparities in cervical cancer incidence, mortality, and disability-adjusted life years in Europe, 1990-2023.

Abstract

e17520 Background: Cervical cancer remains a public health concern in Europe despite effective prevention strategies, including HPV vaccination and organized screening. Although mortality has declined in many countries, progress has been uneven, with persistent regional disparities. We assessed long-term regional trends in cervical cancer incidence, mortality, and disability-adjusted life years (DALYs) across Europe. Methods: We conducted a GBD estimates-based analysis of cervical cancer incidence, mortality, and DALYs among females in Europe from 1990 to 2023 using publicly available data. Estimates were stratified by Western, Central, and Eastern Europe and expressed as age-standardized rates per 100,000 population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC). Average annual percent change (AAPC) and 95% confidence intervals (CIs) were calculated as weighted averages across the study period. Results: From 1990 to 2023, cervical cancer incidence declined across Europe, with marked regional variation. Incidence decreased most in Western Europe (AAPC: −1.42%; 95% CI: −1.59 to −1.24) and Central Europe (AAPC: −1.27%; 95% CI: −1.35 to −1.19), driven by sustained declines after 2007 in Central Europe (APC: −2.41%; 95% CI: −2.48 to −2.35) and during 2001–2023 in Western Europe (APC: −1.89%; 95% CI: −2.03 to −1.75), following modest increases or stabilization during the 1990s. Eastern Europe showed an early rise (1990–1993; APC: 1.48%; 95% CI: −0.21 to 3.21) followed by prolonged declines after 2003, resulting in a small and non-significant overall change (AAPC: −0.09%; 95% CI: −0.42 to 0.24). In contrast, mortality and DALY rates declined across all subregions, with the largest reductions observed in Western Europe (mortality AAPC: −1.63%; 95% CI: −1.71 to −1.56; DALYs AAPC: −1.74%; 95% CI: −1.81 to −1.66), followed by Eastern Europe (mortality AAPC: −0.55%; 95% CI: −0.82 to −0.28; DALYs AAPC: −0.88%; 95% CI: −1.15 to −0.61) and Central Europe (mortality AAPC: −0.39%; 95% CI: −0.49 to −0.29; DALYs AAPC: −0.70%; 95% CI: −0.79 to −0.60). Trends were non-linear, with early increases in Eastern Europe (1990–1993; mortality APC: 1.65%; 95% CI: 1.05 to 2.25; DALYs APC: 4.60%; 95% CI: 4.07 to 5.14), followed by the steepest declines after 2011 and more gradual reductions in Central and Western Europe. Females experienced greater reductions in mortality, incidence, and DALYs, while trends for both sexes followed similar regional patterns. Conclusions: Despite substantial declines in cervical cancer mortality and DALY burden across Europe, incidence trends remain uneven, with the highest burden persisting in Central and Eastern Europe, underscoring the need for equitable strengthening of HPV vaccination and screening to accelerate cervical cancer elimination.