Rural–Urban Trends and Patterns in Cervical Cancer Mortality, Incidence, Stage, and Survival in the United States, 1950–2008
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This study examined disparities in cervical cancer mortality rates among US women in metropolitan and non-metropolitan areas from 1950 through 2007. Inequalities in incidence, stage of disease at diagnosis, and patient survival were analyzed during 2000–2008. Age-adjusted mortality, incidence, and 5-year relative survival rates were calculated for women in metropolitan and non-metropolitan areas, and differences in relative risks were tested for statistical significance. Log-linear regression was used to analyze annual rates of change in mortality over time. During the last five decades, women in non-metropolitan areas had significantly higher cervical cancer mortality than those in metropolitan areas. Disparities persisted against a backdrop of consistently declining mortality rates. Throughout 1969–2007, both white and black women in non-metropolitan areas maintained significantly higher cervical cancer mortality rates than their metropolitan counterparts. Among black women, cervical cancer mortality declined at a faster pace in metropolitan than in non-metropolitan areas. In both metropolitan and non-metropolitan areas, black women had twice the mortality rate of white women. During 2000–2008, white, black, and American Indian women in non-metropolitan areas had significantly higher cervical cancer incidence rates than their metropolitan counterparts. Survival rates were significantly lower in non-metropolitan areas, particularly among rural black women. The 5-year survival rate for black women diagnosed with cervical cancer was 50.8% in non-metropolitan areas, compared with 60.2% for black women and 71.0% for white women in metropolitan areas. Disparities in survival existed after controlling for disease stage. Rural–urban disparities in cervical cancer have persisted despite steep declines in incidence and mortality rates.
KeywordsUrbanization Metropolitan Nonmetropolitan Cervical cancer mortality Incidence Stage of disease Patient survival Race/ethnicity Time trend
Conflicts of interest
Human Subjects Review
No IRB approval was required for this study, which is based on the secondary analysis of public-use federal databases.
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