State-level progress in reducing cervical cancer incidence among US young women between the pre- and post-human papillomavirus vaccination eras.

Abstract

Despite well-documented national declines in cervical cancer incidence among young women following human papillomavirus (HPV) vaccine implementation, state-level data remain limited. Using the US Cancer Statistics Database, differences in cervical cancer incidence rates for women aged 20-31 between the pre-vaccination (2000-2005) and vaccination era (2016-2021) were estimated using rate ratios (RRs) across 47 states and the District of Columbia (DC). Associations between HPV vaccination rates from the National Immunization Survey-Teen and RRs were examined using Spearman's rank test and linear regression models, adjusted for screening rates from the Behavioral Risk Factor Surveillance System. Nationwide, cervical cancer incidence rates declined by 27% (RR = 0.73, 95%CI:0.70 to 0.75) during the vaccination era, from 5.1 to 3.7 per 100,000. Reductions exceeded 50% in DC (RR = 0.48, 95%CI : 0.15 to 0.81), Rhode Island (RR = 0.48, 95%CI : 0.21 to 0.76), Michigan (RR = 0.48, 95%CI : 0.38 to 0.57), and Hawaii (RR = 0.49, 95%CI : 0.21 to 0.78), with 28 additional states achieving statistically significant reductions of 15-50%. Ten states showed slower decreases (<15%). Notably, progress was lacking in Vermont (RR = 1.11; 95%CI : 0.21 to 2.00), West Virginia (RR = 1.09; 95%CI : 0.63 to 1.56), Idaho (RR = 0.97; 95%CI : 0.42-1.52), Arkansas (RR = 0.96; 95%CI : 0.64 to 1.29), and Alabama (RR = 0.96; 95%CI : 0.71 to 1.21). Across states, higher vaccination rates were correlated with lower RRs (i.e., faster decline) (rho=-0.42, P = .0027). Every 10% increase in vaccination rates was associated with an 11.5% (95%CI : -17.2% to -5.4%) reduction in RRs, adjusted for screening rates. Declines in cervical cancer incidence in young women during the HPV vaccination era varied substantially by state, aligning with HPV vaccination rates.