title: Rural-urban trends and patterns in cervical cancer mortality, incidence, stage, and survival in the United States, 1950-2008.
abstract: 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.
authors.affiliation: US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA. gsingh@hrsa.gov
authors.forename: Gopal K
authors.initials: GK
authors.lastname: Singh
mesh_terms: D016208:Databases, Factual; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D009367:Neoplasm Staging; D012423:Rural Health / Q000639:trends*; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000639:trends*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology