Health disparities in cervical cancer: Estimating geographic variations of disease burden and association with key socioeconomic and demographic factors in the US

• Published in: PloS one 2024-07, Vol.19 (7), p.e0307282
• Main Authors: Castellano, Tara, ElHabr, Andrew K, Washington, Christina, Ting, Jie, Zhang, Yitong J, Musa, Fernanda, Berksoy, Ezgi, Moore, Kathleen, Randall, Leslie, Chhatwal, Jagpreet, Ayer, Turgay, Leath, 3rd, Charles A
• Format: Article
• Language: English
• Subjects: Access to information; Adult; Aged; Analysis; Beneficiaries; Brachytherapy; Cancer; Cancer therapies; Care and treatment; Cellular biology; Cervical cancer; Cost of Illness; Datasets; Demographic variables; Demographics; Demography; Disease; Diseases; Early Detection of Cancer - statistics & numerical data; Earth Sciences; Ethnicity; Female; Females; Geographical distribution; Geographical variations; Geography; Health aspects; Health disparities; Health services; Health Status Disparities; Healthcare Disparities - statistics & numerical data; Human papillomavirus; Humans; Hypotheses; Medicaid; Medical diagnosis; Medical research; Medical screening; Medicare; Medicine and Health Sciences; Medicine, Experimental; Metastases; Metastasis; Middle Aged; Minority & ethnic groups; Patients; Population studies; Race; Radiation therapy; Radioisotope brachytherapy; Risk Factors; Social behavior; Social factors; Socioeconomic Factors; Socioeconomics; United States - epidemiology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - epidemiology; Uterine Cervical Neoplasms - therapy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0307282

Despite advances in cervical cancer (CC) prevention, detection, and treatment in the US, health disparities persist, disproportionately affecting underserved populations or regions. This study analyzes the geographical distribution of both CC and recurrent/metastatic CC (r/mCC) in the US and explores potential risk factors of higher disease burden to inform potential strategies to address disparities in CC and r/mCC. We estimated CC screening rates, as well as CC burden (number of patients with CC diagnosis per 100,000 eligible enrollees) and r/mCC burden (proportion of CC patients receiving systemic therapy not in conjunction with surgery or radiation), at the geographic level between 2017-2022 using administrative claims. Data on income and race/ethnicity were obtained from US Census Bureau's American Community Survey. Brachytherapy centers were proxies for guideline-conforming care for locally advanced CC. Associations among demographic, socioeconomic, and healthcare resource variables, with CC and r/mCC disease burden were assessed. Between 2017-2022, approximately 48,000 CC-diagnosed patients were identified, and approximately 10,000 initiated systemic therapy treatment. Both CC and r/mCC burden varied considerably across the US. Higher screening was significantly associated with lower CC burden only in the South. Lower income level was significantly associated with lower screening rates, higher CC and r/mCC burden. Higher proportion of Hispanic population was also associated with higher CC burden. The presence of ≥1 brachytherapy center in a region was significantly associated with a reduction in r/mCC burden (2.7%). CC and r/mCC disparities are an interplay of certain social determinants of health, behavior, and race/ethnicity. Our findings may inform targeted interventions for a geographic area, and further highlight the importance of guideline-conforming care to reduce disease burden.