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

ORIGINAL RESEARCH — Volume 16 — June 6, 2019

Lulu Yu, MD1; Susan A. Sabatino, MD2; Mary C. White, ScD2 (View author affiliations)

Suggested citation for this article: Yu L, Sabatino SA, White MC. Rural–Urban and Racial/Ethnic Disparities in Invasive Cervical Cancer Incidence in the United States, 2010–2014. Prev Chronic Dis 2019;16:180447. DOI: http://dx.doi.org/10.5888/pcd16.180447.

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Summary

What is already known on this topic?

Race/ethnicity and rural residence are associated with poorer cervical cancer outcomes.

What is added by this report?

We examined the association of rurality with cervical cancer stage at diagnosis by race/ethnicity in the US Cancer Statistics dataset for 2010–2014. Black and Hispanic women had higher incidence of regional and distant stage cancer than white women overall. Rural residents had higher rates of cervical cancer than urban residents at every stage (localized, regional, distant, and unknown). The association of rural residence with incidence varied by race/ethnicity.

What are the implications for public health practice?

Findings support the need for continued efforts to provide and promote cervical cancer screening in rural areas and among minority women.

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.