Mapping Preventable Cervical Cancer Deaths in Brazil: Geographic and Racial Inequities in a Nationwide Study of 84,794 Deaths, 2010-2023

Abstract

Cervical cancer is largely preventable, yet mortality persists where HPV vaccination, screening, referral, and timely treatment fail to reach populations equitably. Brazil is a middle-income country with universal health care, continental heterogeneity, and vital records capturing race/color, enabling unusually granular subnational analysis. We quantified temporal trends and intersecting geographic-racial patterns in cervical cancer mortality across all 27 federative units from 2010-2023, spanning Brazil’s 2014 national HPV vaccination rollout. We conducted a nationwide ecological study using female cervical cancer deaths from SIM/DATASUS (ICD-10 C53). Population denominators came from official IBGE population estimates. Annual and state-level crude rates were calculated per 100,000 women. Regional period age-standardized mortality rates used age-specific deaths and population denominators across 2010-2023, directly standardized to the WHO 2000 population. APC was estimated by log-linear regression. RRs and 95% CIs used Poisson approximation. Race/color was analyzed as recorded in SIM. Brazil recorded 84,794 deaths, increasing from 4,986 in 2010 to 7,209 in 2023 (+44.6%); after accounting for female population growth, crude mortality rose from 5.01 to 6.65/100,000 (APC +2.20%/year, 95% CI +1.87 to +2.53; R 2 = 0.947). In 2023, state-level crude mortality varied 3.24-fold, from 4.66/100,000 in Minas Gerais to 15.10/100,000 in Acre. The period age-standardized North-South gradient was substantial: 13.27 versus 5.86/100,000 (RR 2.26, 95% CI, 2.21 to 2.32), corresponding to approximately 9,000 excess deaths in the North relative to the South reference. Among deaths classified as White, Brown, or Black, Brown women represented 78.1% in the North, whereas White women represented 84.5% in the South, reflecting regional racial-demographic composition. Preventable cervical cancer mortality in Brazil is rising and remains geographically concentrated despite universal health care. National averages conceal substantial within-country inequities that follow regional and racial-demographic patterns. These findings support targeted strengthening of HPV vaccination, organized screening, referral, and timely treatment, and offer a data-driven model for monitoring within-country cancer inequities in middle-income settings.