ArticleThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association2025
What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence?
Article in The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Consideration for HPV vaccination recommendations in patients with vulvar dysplasia and malignancy following resection: A retrospective study investigating rural-urban vaccination practices in patients served by an academic medical center in the heartland.Gynecologic oncology reports · 2026Article
- Evaluating intersectional variation of HPV-associated cancers in rural America.BMC public health · 2025Article
- Health Equity and Human Papillomavirus Vaccine Interventions for Adolescents: A Systematic Review.Vaccines · 2025Review
- What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence?The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
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Authors and funding
3 authors.
Funding
Abstract
purposeHuman papillomavirus (HPV) can cause cancers of the genital system, anus/rectum, and oropharynx. Prior research showed that HPV-associated cancer incidence was rising faster in nonmetro than in metro populations. Our study identified which cancers contributed to the widening disparity.
methodsRepresenting ∼93% of all cancers in the United States, we analyzed data from the North American Association of Central Cancer Registries (2000-2019). Restricting the analysis to HPV-associated cancers, we compared 5-year average age-adjusted incidence rates (per 100,000 population) for nonmetropolitan (Rural-Urban Continuum Codes 4-9) and metropolitan populations, by sex and cancer site. To quantify the rural-urban gap, we calculated rate ratios and absolute differences of incidence trends.
resultsAlthough incidence was similar in 2000-2004 (nonmetropolitan = 9.9; metropolitan = 9.9), incidence in 2015-2019 was significantly higher in nonmetropolitan (12.3) than metropolitan (11.1) populations. The gap was widest for cervical cancers (females) in 2015-2019 (1.0 case per 100,000) but grew the most since 2000-2004 in oropharyngeal cancers among males (+1.1 cases per 100,000). The nonmetropolitan rate ratios for females (RR = 1.15, 95% C.I. = 1.13, 1.17) and males (RR = 1.07, 95% C.I. = 1.05, 1.09) in 2015-2019 were higher than the respective RRs for all other years. Since 2000, the nonmetropolitan disparity has significantly grown for anal and cervical cancers in females, and oropharyngeal cancers in both sexes. DISCUSSION: Although preventable, nonmetropolitan Americans have shouldered a growing burden of HPV-associated cancers. To address these cervical, anal, and oropharyngeal cancer disparities, it is imperative that HPV vaccination programs are effectively implemented at scale.
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