Long-term mortality trends of cervical cancer among younger and middle-aged women in the United States.

Abstract

e17504 Background: Despite increasing human papillomavirus (HPV) immunization rates, the incidence of cervical cancer has declined disappointingly slowly in the United States (US). In this retrospective study, we aimed to analyze temporal trends, geographic variations, and disparities among younger and middle-aged women in the US. Methods: Using the CDC WONDER database for women aged 25-64 years, we analyzed age-adjusted and crude mortality rates (AAMRs and CMRs) per 100,000 for cervical cancer (ICD-10: C53) by year, race/ethnicity, and geography. Joinpoint regression (version 5.4) estimated average annual percentage change (AAPC) and annual percentage change (APC) with 95% confidence interval (CIs). Results: From 1999 to 2023, cervical cancer caused 69,631 deaths among younger and middle-aged women, most occurring at the Decedent's home. The overall AAMR slightly declined from 3.79 in 1999 to 3.00 in 2023 (AAPC: -0.99; 95% CI: -1.77 to -0.20; p=0.014), with the most significant decrease between 1999 and 2004 (APC: -3.02, 95% CI: -4.18 to -1.85; p<0.001). Women aged 45-64 years had the highest CMR with an annual decrease of -3.75% (p<0.001). Regarding racial disparities, Non-Hispanic (NH) Blacks or African Americans had the greatest AAMR with the fastest decrease at -5.05% (p<0.001), while NH Asians or Pacific islanders had the lowest AAMR. Regionally, the South showed the highest AAMR, while the Northeast showed the lowest, although the decrease was steeper in the Northeast at -1.83% (p < 0.001). Rural regions consistently outperformed urban areas, although urban locations showed a rapid improvement (AAPC: -1.00 vs -0.15). Conclusions: While cervical cancer mortality has been decreasing since 1999, not all demographic groups have experienced the same rates of decline, and disparities in outcomes remain prevalent. Vulnerable subgroups may benefit and achieve favorable outcomes from targeted treatment strategies and equitable healthcare access. Deaths and age-adjusted mortality rates (AAMRs) per 100,000 for trends related to cervical cancer among younger and middle-aged women in the US, 1999 to 2023. Variable Deaths AAMR (95%CI)1999 AAMR (95% CI)2023 Overall 69,631 3.79(3.65 to 3.93) 3.00(2.88 to 3.11) NH Blacks 13,125 6.37(5.83 to 6.91) 1.99(1.80 to 2.18) NH Asians 2,684 2.91(2.31 to 3.61) 1.04(0.86 to 1.23) South 3,509 4.21(3.96 to 4.46) 3.71(3.51 to 3.92) Northeast 10,720 3.70(3.39 to 4.02) 2.17(1.93 to 2.41) Rural 10,720 4.54(4.15 to 4.93) (2020)4.22(3.83 to 4.61) Urban 5,474 3.68(3.53 to 3.84) 3.06(2.93 to 3.18)