Geographic and racial disparities in cervical cancer mortality in the United States: A 21-year retrospective analysis.

244 Background: Cervical cancer remains one of the few malignancies that is largely preventable due to the availability of the Human Papillomavirus (HPV) vaccine and routine screening. While previous research has highlighted racial disparities and trends in the vaccine era, a comprehensive, state-level analysis examining geographic, racial/ethnic, and urbanization-related differences is lacking. Methods: We utilized the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to examine cervical cancer mortality among U.S. females from 1999 to 2020. Cases were identified using ICD-10 codes. Data were stratified by state, race/ethnicity, and urbanization level. Age-adjusted mortality rates (AAMRs) per 100,000 females were calculated, with 95% confidence intervals (CIs), and annual percentage change (APC) was reported. States with fewer than 10 years of valid data were excluded from comparative analyses. Results: Cervical cancer resulted in an average of 12,020 deaths annually. Nationally, mortality declined by 1.55% per year (95% CI: –1.75 to –1.36); however, this progress was uneven across populations. The highest AAMRs were observed in Mississippi (5.47), Tennessee (5.01), Alabama (4.96), Texas (4.67), and Illinois (4.62), while the lowest were in Minnesota (1.67), Massachusetts (1.67), Wisconsin (1.95), Connecticut (1.99), and Colorado (2.16). By observing the trends between the highest and lowest mortality nationwide, at least a 3.3-fold disparity between states was noted. Black women experienced the highest mortality rates, particularly in Southern and rural areas, despite significant improvements in states like New Jersey (APC: –3.60%; 95% CI: –4.88 to –2.31) and Virginia (–3.51%; 95% CI: –4.44 to –2.58). Conversely, White women in Alabama experienced a significant increase in mortality (APC: +1.08%; 95% CI: +0.15 to +2.03), countering national trends. By urbanization level, the largest declines occurred in large metropolitan areas, particularly among Asian (–3.79%; 95% CI: –5.24 to –2.32) and Black women (–2.59%; 95% CI: –2.97 to –2.20). White women saw modest improvements (–1.17%; 95% CI: –1.47 to –0.88), while rural areas experienced smaller and less consistent changes. Conclusions: Although cervical cancer mortality has declined nationally, the benefits have not been equitably realized. The disparity between states and urbanization underscores the persistent regional and structural inequities in cancer prevention and care. It is crucial that these gaps be addressed proactively through targeted, community-informed interventions in order to mitigate mortality trends and promote equity.