Cervical Cancer Mortality Trends in Brazil, 2000-2024: A Nationwide Epidemiological Analysis With Racial and Socioeconomic Disparities

Abstract

Cervical cancer remains a preventable yet persistently lethal malignancy in low- and middle-income countries. We aimed to characterize 25-year national mortality trends in Brazil, identify temporal acceleration, and evaluate disparities by race, education, and region. Death counts from Brazil's Mortality Information System (SIM/DATASUS; ICD C53) and female population estimates from IBGE 2024 projections were analyzed for 2000-2024. Crude mortality rates and age-standardized mortality rates (ASMR) were computed per 100,000 females using the WHO World Standard Population (direct standardization). Temporal trends were modeled via negative binomial regression (offset: log-population) and joinpoint regression, reporting Annual Percent Change (APC), Average APC (AAPC), and 95% CIs. Racial and educational disparities were assessed through Spearman rank correlation. Regional trends were evaluated with Mann-Kendall tests. A total of 136,881 cervical cancer deaths were recorded in Brazil over the study period. Crude mortality rose from 4.45 to 6.88 per 100,000 females (+54.8%), while ASMR increased more modestly from 5.23 to 5.76 per 100,000 (+10.0%), indicating that population aging substantially drove the crude rate increase. Negative binomial regression confirmed a sustained upward trend (APC = +1.80 [95% CI, 1.66 to 1.94]; P < .001; IRR = 1.018 per year). Joinpoint analysis identified a statistically significant inflection point in 2016 (F = 10.10, P = .0008), with acceleration from APC = +1.39% (2000-2016) to APC = +1.96% (2016-2024); AAPC = 1.58%. The Northern region carried the highest and fastest-growing burden (4.42 to 10.30/100,000; τ = 0.920, P < .001), approximately double the Southeastern rate (5.43/100,000 in 2024). The proportion of deaths among Black women (Preta+Parda) rose from 38.5% to 58.3% over the study period (Spearman ρ = 0.946; P < .001). Socioeconomic vulnerability was marked: 46.8% of deaths occurred in women with three or fewer years of formal education, versus 5.8% among those with 12 or more years. Cervical cancer mortality in Brazil increased significantly over 25 years, with a marked acceleration after 2016. Stark racial, educational, and geographic disparities reveal structural inequities in cancer prevention access. Urgent expansion of HPV vaccination coverage and cervical screening programs in the North, Northeast, and among Black and low-income women is warranted to avert preventable deaths.