Disparities in survival after cervical cancer between tribal and rural women in Tamil Nadu, India: A retrospective cohort study.

Abstract

Tribal women in India face inequitable access to health care and are at high risk of cervical cancer. However, no disaggregated data on cervical cancer survival for such populations are currently available, to support the need for focused health policies and programmes. We compared the survival experience of women diagnosed with cervical cancer between 2014 and 2022, from defined rural (population 116,000) and tribal areas (population 63,822) in Vellore and Tiruvannamalai districts in Tamil Nadu, South India. Cases were identified through patient registries at healthcare facilities and ongoing population-based surveillance based on reporting by community health workers. The outcome was time to death due to cervical cancer recorded in the routine demographic surveillance system. Analysis was conducted using Kaplan-Meier curves and Cox proportional hazards regression. Among the 77 women (30 tribal, 47 rural) identified with cervical cancer, the mean age at diagnosis was 46 years among tribal women, compared to 54 years among rural women (<i>t</i> test <i>P</i> value 0.002). Tribal women experienced 2.02 (95% confidence interval: 1.03-3.96) times higher mortality within five years, after adjusting for age and stage at diagnosis. The higher mortality in tribal women, even after adjusting for age and the stage of diagnosis, indicates inequities in access to health care for the treatment of cervical cancer. India needs to improve access to affordable, culturally appropriate cancer treatment and cervical screening, to ensure equitable survival outcomes for all affected women.