Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States

Wonsuk Yoo, Sangmi Kim, Warner K. Huh, Sarah Dilley, Steven Scott Coughlin, Edward E. Partridge, Yunmi Chung, Vivian Gail Dicks, Jae Kwan Lee, Sejong Bae

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Article numbere0172548
JournalPloS one
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2017

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Epidemiology
uterine cervical neoplasms
Uterine Cervical Neoplasms
Screening
incidence
Mortality
Incidence
hysterectomy
Registries
Hysterectomy
SEER Program
epidemiology
Software

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. / Yoo, Wonsuk; Kim, Sangmi; Huh, Warner K.; Dilley, Sarah; Coughlin, Steven Scott; Partridge, Edward E.; Chung, Yunmi; Dicks, Vivian Gail; Lee, Jae Kwan; Bae, Sejong.

In: PloS one, Vol. 12, No. 2, e0172548, 01.02.2017.

Research output: Contribution to journalArticle

Yoo, Wonsuk ; Kim, Sangmi ; Huh, Warner K. ; Dilley, Sarah ; Coughlin, Steven Scott ; Partridge, Edward E. ; Chung, Yunmi ; Dicks, Vivian Gail ; Lee, Jae Kwan ; Bae, Sejong. / Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. In: PloS one. 2017 ; Vol. 12, No. 2.
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AU - Yoo, Wonsuk

AU - Kim, Sangmi

AU - Huh, Warner K.

AU - Dilley, Sarah

AU - Coughlin, Steven Scott

AU - Partridge, Edward E.

AU - Chung, Yunmi

AU - Dicks, Vivian Gail

AU - Lee, Jae Kwan

AU - Bae, Sejong

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N2 - 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.

AB - 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.

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