Trends in rural-urban disparities in U.S. cervical cancer mortality before and after the HPV vaccine introduction: A CDC analysis, 1999-2023.

Abstract

5535 Background: Cervical cancer mortality has declined in the United States following the introduction of HPV vaccination. However, disparities by urbanization, geography, and race may persist. Rural women remain up to 40% more likely to die from cervical cancer. Understanding rural–urban trends is essential to guiding equitable prevention strategies. Methods: CDC WONDER mortality data for females ≥15years with cervical cancer (ICD-10 C53) were analyzed. Age-adjusted mortality rates (AAMR) per 100,000 population were analyzed. Urbanization data were available till 2020 and were used for urban–rural stratification (NCHS classification). Temporal trends were assessed using joint point regression to determine average annual percent change (AAPC). Results: Between 1999 and 2023, 102,205 cervical cancer deaths were identified. The overall AAMR declined from 1.52 to 1.28 during the pre-vaccine era (1999–2005; AAPC = –2.95%, 95% CI –4.0 to –1.8) and further to 1.09 during the post-vaccine era (2006–2023; AAPC = –0.86%, 95% CI –1.0 to –0.7). Rural-urban mortality (AAMR) ratio increased in post-vaccine era from 1.13 vs 1.15 with 1.47% increase in disparity. By urbanization, declines were greatest in central metropolitan areas (AAMR 1.72 to 1.48 pre-vaccine; 1.14 post-vaccine; AAPC = –1.40%, 95% CI –1.6 to –1.2), while small metro (1.36 to 1.29 pre-vaccine; 1.11 post-vaccine; AAPC = –0.93%, 95% CI –1.2 to –0.6) and micropolitan areas (1.70 to 1.44 pre-vaccine; 1.32 post-vaccine; AAPC = –0.34%, 95% CI –1.3 to 0.6) showed slower improvement which widened mortality gap. Subgroup analyses showed the steepest mortality declines among women aged ≥75 years (AAPC = –3.66%), among Black women (AAPC = –2.81%), and in the Northeast region (AAPC = –2.16%). Conclusions: U.S. cervical cancer mortality declined after the HPV vaccine introduction; however, rural–urban, racial, and regional disparities persisted. Declines were slower in small metropolitan and nonmetropolitan areas and highest among Black individuals, underscoring the need for targeted vaccination, screening efforts and access-to-care.