title: Geographic poverty and racial/ethnic disparities in cervical cancer precursor rates in Connecticut, 2008-2009.
abstract: OBJECTIVE
  We examined associations of geographic measures of poverty, race, ethnicity, and city status with rates of cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ (CIN2+/AIS), known precursors to cervical cancer.
  
  
  METHODS
  We identified 3937 cases of CIN2+/AIS among women aged 20 to 39 years in statewide surveillance data from Connecticut for 2008 to 2009. We geocoded cases to census tracts and used census data to calculate overall and age-specific rates. Poisson regression determined whether rates differed by geographic measures.
  
  
  RESULTS
  The average annual rate of CIN2+/AIS was 417.6 per 100,000 women. Overall, higher rates of CIN2+/AIS were associated with higher levels of poverty and higher proportions of Black residents. Poverty was the strongest and most consistently associated measure. However, among women aged 20 to 24 years, we observed inverse associations between poverty and CIN2+/AIS rates.
  
  
  CONCLUSIONS
  Disparities in cervical cancer precursors exist for poverty and race, but these effects are age dependent. This information is necessary to monitor human papillomavirus vaccine impact and target vaccination strategies.
authors.affiliation: Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, CT 06520, USA. linda.niccolai@yale.edu
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Julian
authors.forename: Alyssa
authors.initials: A
authors.lastname: Bilinski
authors.forename: Niti R
authors.initials: NR
authors.lastname: Mehta
authors.forename: James I
authors.initials: JI
authors.lastname: Meek
authors.forename: Daniel
authors.initials: D
authors.lastname: Zelterman
authors.forename: James L
authors.initials: JL
authors.lastname: Hadler
authors.forename: Lynn
authors.initials: L
authors.lastname: Sosa
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology* / Q000473:pathology; D000328:Adult; D044383:Black People; D003237:Connecticut / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005843:Geography; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D060787:Neoplasm Grading; D011203:Poverty / Q000208:ethnology*; D011230:Precancerous Conditions / Q000208:ethnology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000208:ethnology* / Q000473:pathology; D044465:White People; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000208:ethnology* / Q000473:pathology; D001741:Black or African American