Cervical cancer mortality trends and disparities in women of the United States: A two-decade retrospective analysis.

Abstract

e17509 Background: Cervical cancer is a cancerous growth of cells in the cervix. It usually has an insidious development. Most cervical cancers are squamous cell carcinomas (90%). The aim of this study was to analyze cervical cancer mortality trends in women of the U.S. over 2 decades, reporting age-adjusted mortality rates (AAMR), disparities, and geographic variations. Methods: A retrospective study spanning 1999-2020 was conducted and data was utilized from the death certificates from the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database regarding mortality from cervical cancer. The data included all 50 states of the United States and the District of Columbia. Female only data was examined. Stratification based on age, race, urbanization, census region and place of death was performed. Age-Adjusted Mortality Rates (AAMR) per 100,000 females were calculated with corresponding 95% confidence intervals (CIs) and results were reported as Annual Percentage Change (APC). Results: Between 1999-2020, 100,265 women lost their lives due to cervical cancer. The age adjusted mortality rate was 3.185 (95%CI; 3.095 to 3.276) in 1999 which decreased significantly to 2.673 (95%CI; 2.593 to 2.754) in 2004 (APC= -3.62). It was followed by a much slower decline to 2.491 (95%CI; 2.419 to 2.564) in 2020 (APC= -0.65). Upon racial stratification, Black or African American females exhibited disproportionately higher mortality than other races. The AAMR in this subgroup was 6.195 (95%CI; 5.800 to 6.590) in 1999, which decreased rapidly to 5.138 (95%CI; 4.794 to 5.481) in 2003 (APC= -4.95), this was followed by a slower decline to 3.442 (95%CI; 3.209 to 3.675) in 2020 (APC= -2.43). In contrast, the white females had an AAMR of 2.883 (95%CI; 2.789 to 2.977) in 1999 which decreased rapidly to 2.434 (95%CI; 2.349 to 2.519) in 2004 (APC= -3.51) but was stagnant afterwards with a value of 2.463 till 2020 (APC= -0.15). Geographically, non-metropolitan areas had significantly higher mortality than metropolitan areas (average AAMR 3.072 vs 2.572 respectively). After stratification by age group, 65+ age females had the highest mortality rates at 9.425 (95%CI; 9.067 to 9.906) in 1999, which decreased considerably to 6.496 (95%CI; 6.210 to 6.783) in 2020 (APC= -2.07). Upon regional analysis, The South region had considerably higher mortality rate than other regions with an average AAMR of 3.01 (95%CI; 2.881 to 3.157). Decedent’s home was the most common place of death at 39,932 deaths (39.83%). Conclusions: The mortality due to cervical cancer has decreased over the past 2 decades. Despite the decrease, there are significant disparities in mortality in certain groups especially elderly females, Black or African American females, and females in the southern region. Targeted approaches are necessary to lower the mortality rates in these groups.