In a study reported as a research letter in JAMA Network Open, Amboree et al found that women with cervical cancer living in rural U.S. counties had poorer outcomes than those living in urban counties.
Study Details
The trial used data from the National Program of Cancer Registries and Surveillance, Epidemiology, and End Results from 2001 to 2019. A total of 222,425 patients with cervical cancer were identified; of them, 84.3% were from urban counties, and 59% were White women.
Key Findings
Overall, hysterectomy-corrected incidence rates were 11.9 per 100,000 population in rural counties and 10.0 per 100,000 in urban counties. Incidence increased (annual percentage change [APC] = 0.85%, 95% confidence interval [CI] = 0.08%–2.05%) in rural counties in 2012 to 2019 after decreasing in 2001 to 2012; in urban counties, incidence remained stable in 2013 to 2019 (APC = –0.03%, 95% CI = –0.89% to 2.00%) after decreasing in 2001 to 2013.
The difference in incidence between groups increased between 2013 and 2019, with rate ratios (RRs) of 1.16 (95% CI = 1.10–1.22) in 2013 and 1.25 (95% CI = 1.19–1.31) in 2019. Among rural White women, the APC was 1.05% (95% CI = 0.24%–2.33%) in 2012 to 2019. The APC among rural Black women was 9.07% (95% CI = −2.84% to 17.84%) in 2017 to 2019, although the change was not statistically significant.
Mortality was higher (RR = 1.42, 95% CI = 1.33–1.51) in rural vs urban counties in 2015 to 2019. During this period, mortality was higher among rural Hispanic women (RR = 1.33, 95% CI = 1.12–1.58), rural Black women (RR = 1.58, 95% CI = 1.32–1.90), and rural White women (RR = 1.54, 95% CI = 1.43–1.67) vs urban women.
The investigators stated: “This cross-sectional study found a recent increase in cervical cancer incidence in rural U.S. counties, specifically among White women. In addition, incidence was 25% higher and mortality was 42% higher in rural vs urban counties in recent years. The increase in incidence and mortality in rural U.S. counties may reflect lower screening coverage…and lower utilization of diagnostic and therapeutic care, likely resulting from heightened access barriers experienced in rural areas.”
Trisha L. Amboree, PhD, MPH, of the Department of Public Health Sciences, Medical University of South Carolina, Charleston, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was supported by the National Institute on Minority Health and Health Disparities, National Cancer Institute, and others. For full disclosures of the study authors, visit jamanetwork.com.
