Reducing Poverty-Related Disparities in Cervical Cancer: The Role of HPV Vaccination.
Jennifer C Spencer, Noel T Brewer, Tamera Coyne-Beasley, Justin G Trogdon, Morris Weinberger, Stephanie B Wheeler
Author Information
Jennifer C Spencer: Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. jennifer_spencer@austin.utexas.edu. ORCID
Noel T Brewer: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Tamera Coyne-Beasley: Departments of Pediatrics and Internal Medicine, Division of Adolescent Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Justin G Trogdon: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. ORCID
Morris Weinberger: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Stephanie B Wheeler: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
BACKGROUND: Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. METHODS: We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). RESULTS: We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. CONCLUSIONS: High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. IMPACT: Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.
References
Cancer. 2013 Aug 15;119(16):3052-8
[PMID: 23661284]
Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1114-1121
[PMID: 33771846]
Cancer Epidemiol Biomarkers Prev. 2006 Nov;15(11):2154-9
[PMID: 17119040]
