Declining trends but persistent disparities in cervical cancer mortality in the United States, 1999–2023

Abstract

Cervical cancer is largely preventable through effective screening and human papillomavirus (HPV) vaccination; however, mortality disparities remain a persistent public health challenge in the United States. This study aimed to examine long-term trends and socio-demographic and geographic inequalities in cervical cancer mortality. We conducted a population-based study of cervical cancer mortality among U.S. women aged ≥25 years from 1999 to 2023 using national mortality data from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Analyses were stratified by census region, race/ethnicity, urbanization level, age group, and state. Age restrictions were harmonized across bridged-race and single-race population estimates, and corrected estimates were used for trend analyses. Overall cervical cancer mortality declined substantially from 1999 to 2023, with the female-specific AAMR decreasing from 4.37 to 2.09 per 100,000 women (AAPC, −3.27%; 95% CI, −3.81 to −2.73). Despite this overall decline, substantial disparities persisted. Mortality rates remained consistently higher in the Southern region and lowest in the Northeast, which showed the greatest reduction over time (AAPC, −4.23%; 95% CI, −5.31 to −3.13). Non-Hispanic Black women experienced persistently higher mortality compared with other racial and ethnic groups, and women residing in nonmetropolitan areas had elevated mortality rates. Considerable geographic variation was observed across states, with mortality rates in higher-burden states approximately two- to four-fold higher than those in lower-burden states. Sensitivity analyses restricted to women aged ≥25 years confirmed consistent long-term mortality trends between bridged-race and corrected single-race estimates. No evidence of an accelerated decline around 2019/2020 was identified, and the previously reported post-2019 acceleration was attributable to inconsistent age restrictions during data extraction rather than a true epidemiological change. Although cervical cancer mortality has declined significantly in the United States over the past two decades, substantial socio-demographic and geographic disparities persist. These findings highlight the need for targeted public health strategies to improve equitable access to screening, HPV vaccination, and timely treatment, particularly in high-risk populations and underserved regions.