title: Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States.
abstract: The objectives of this study were to determine the age-standardized and age-specific annual US cervical cancer mortality rates after correction for the prevalence of hysterectomy and to evaluate disparities by age and race.
  
  
  
  Estimates for deaths due to cervical cancer stratified by age, state, year, and race were derived from the National Center for Health Statistics county mortality data (2000-2012). Equivalently stratified data on the prevalence of hysterectomy for women 20 years old or older from the Behavioral Risk Factor Surveillance System survey were used to remove women who were not at risk from the denominator. Age-specific and age-standardized mortality rates were computed, and trends in mortality rates were analyzed with Joinpoint regression.
  
  
  
  Age-standardized rates were higher for both races after correction. For black women, the corrected mortality rate was 10.1 per 100,000 (95% confidence interval [CI], 9.6-10.6), whereas the uncorrected rate was 5.7 per 100,000 (95% CI, 5.5-6.0). The corrected rate for white women was 4.7 per 100,000 (95% CI, 4.6-4.8), whereas the uncorrected rate was 3.2 per 100,000 (95% CI, 3.1-3.2). Without the correction, the disparity in mortality between races was underestimated by 44%. Black women who were 85 years old or older had the highest corrected rate: 37.2 deaths per 100,000. A trend analysis of corrected rates demonstrated that white women's rates decreased at 0.8% per year, whereas the annual decrease for black women was 3.6% (P < .05).
  
  
  
  A correction for hysterectomy has revealed that cervical cancer mortality rates are underestimated, particularly in black women. The highest rates are seen in the oldest black women, and public health efforts should focus on appropriate screening and adequate treatment in this population. Cancer 2017;123:1044-50. © 2016 American Cancer Society.
authors.affiliation: Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Beavis
authors.affiliation: Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC.
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
authors.affiliation: Department of Epidemiology, Bloomberg School of Health at Johns Hopkins, Baltimore, Maryland.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Rositch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009026:Mortality; D062486:Public Health Surveillance; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D055815:Young Adult
keywords: Behavioral Risk Factor Surveillance System; Epidemiology; Surveillance; and End Results (SEER); cervical cancer; disparities; hysterectomy; mortality