title: Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States.
abstract: BACKGROUND
  Although black women experienced greater cervical cancer incidence and mortality rate reduction in recent years, they continue to have higher incidence rates than whites. Great variations also exist among geographic regions of the US, with the South having both the highest incidence and mortality rates compared to other regions. The present study explores the question of whether living in the South is associated with greater racial disparity in cervical cancer incidence and mortality by examining race- and region-specific rates and the trend between 2000 and 2012.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) 18 Program data was used. Cervical cancer incidence and mortality rates, annual percent changes, and disparity ratios were calculated using SEER*Stat software and Joinpoint regression for four groups: US14-Non-Hispanic White (NHW), US14-Non-Hispanic Black (NHB), South-NHW, and South-NHB, where South included 4 registries from Georgia and Louisiana and US14 were 14 US registries except the four South registries.
  
  
  RESULTS
  The average age-adjusted cervical cancer incidence rate was the highest among South-NHBs (11.1) and mortality rate was the highest among US14-NHBs (5.4). In 2012, the degree of racial disparities between South-NHBs and South-NHWs was greater in terms of mortality rates (NHB:NHW = 1.80:1.35) than incidence rates (NHB:NHW = 1.45:1.15). While mortality disparity ratios decreased from 2000-2012 for US14-NHB (APC: -1.9(-2.3,-1.4), mortality disparity ratios for South-NHWs (although lower than NHBs) increased compared to US14-NHW. Incidence rates for NHBs continued to increase with increasing age, whereas rates for NHWs decreased after age 40. Mortality rates for NHBs dramatically increased at age 65 compared to a relatively stable trend for NHWs. The increasing racial disparity with increasing age in terms of cervical cancer incidence rates became more pronounced when corrected for hysterectomy prevalence.
  
  
  CONCLUSIONS
  Black race and South region were associated with higher cervical cancer incidence and mortality. Cervical cancer rates uncorrected for hysterectomy may underestimate regional and racial disparities. Increasing incidence rates for older NHBs compared to NHWs warrant further research to determine whether screening should continue for NHBs over age 65.
authors.affiliation: Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Wonsuk
authors.identifier: http://orcid.org/0000-0003-2414-2399
authors.initials: W
authors.lastname: Yoo
authors.affiliation: Georgia Cancer Center, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Sangmi
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dilley
authors.affiliation: Department of Clinical and Digital Health Sciences, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Coughlin
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Partridge
authors.affiliation: Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America.|Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Yunmi
authors.initials: Y
authors.lastname: Chung
authors.affiliation: Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States of America.
authors.forename: Vivian
authors.initials: V
authors.lastname: Dicks
authors.affiliation: Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
authors.forename: Sejong
authors.initials: S
authors.lastname: Bae
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D005260:Female; D005845:Georgia / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D015994:Incidence; D008145:Louisiana / Q000453:epidemiology; D008875:Middle Aged; D062486:Public Health Surveillance; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality / Q000601:surgery; D044465:White People; D001741:Black or African American