Urban-rural disparities in HPV prevalence and genotype distribution: a large-scale cervical cancer screening study in Xi'an, China.

backgroundCervical cancer remains a major public health challenge in China, with persistent urban-rural disparities in screening coverage. The epidemiological landscape of HPV genotype distribution and screening outcomes across geographic settings remains incompletely characterized. We compared HPV prevalence, genotype distribution, and screening outcomes between urban and rural populations in Xi'an, China, during the post-COVID-19 pandemic period (2023-2025).

methodsThis retrospective cross-sectional study analysed HPV testing records from 16,365 women (11,449 urban, 4,916 rural) screened between January 2023 and December 2025. Primary urban-rural comparisons were restricted to the 15 high-risk genotypes common to both detection platforms (HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68). Histopathological follow-up was characterised within the rural sub-cohort only (matched urban cascade data unavailable). Statistical analyses included chi-square with Bonferroni correction, Wilson 95% CIs, and network analysis for co-infection patterns; significance set at p < 0.05.

resultsAge-standardised HPV prevalence was higher in urban (14.3%, 95% CI: 13.6-15.0%) than rural populations (12.4%, 95% CI: 11.4-13.4%; p = 0.007). HPV52 predominated in both settings (urban: 3.1%, rural: 3.2%), followed by HPV16 (2.4% in both) and HPV58 (urban: 2.4%, rural: 1.6%). Significant urban-rural differences: HPV58 (urban higher; p = 0.002), HPV33 (rural higher; p = 0.003), HPV39 (rural higher; p = 0.012); HPV16, HPV18, HPV52 did not differ. Urban women showed a U-shaped age distribution, while rural women showed a gradual age-related increase. Multiple infections were similar (urban: 4.0%, rural: 3.4%; p = 0.087). HPV52-HPV53 was the most frequent co-infection pair in both networks (urban: 32; rural: 16). Histopathological follow-up in the rural sub-cohort was 11.5% (70/609 HPV-positive women).

conclusionsUrban-rural differences in HPV prevalence and genotype distribution were observed in Northwest China. The crude urban excess (15.5% vs. 12.4%) was substantially attenuated but not eliminated after platform-comparable, age-standardised analysis (14.3% vs. 12.4%; p = 0.007), reflecting detection-platform asymmetry, age structure, and differential healthcare access. HPV52 predominance underscores the need for region-specific vaccination strategies beyond HPV16/18. The 11.5% rural histopathological follow-up rate, far below the WHO 70% minimum, highlights a critical cascade-of-care gap; prospective matched-cohort studies are required to characterise the urban cascade and guide equitable diagnostic strengthening.