Supplementary file 2_Declining trends but persistent disparities in cervical cancer mortality in the United States, 1999–2023.pdf

Age restrictions were harmonized across bridged-race and single-race population estimates, and corrected estimates were used for trend analyses.</p>Results<p>Overall cervical cancer mortality declined substantially from 1999 to 2023, with the female-specific AAMR decreasing from 4.37 to 2.09 per 100,000 women (AAPC, −3.27%; 95% CI, −3.81 to −2.73). Despite this overall decline, substantial disparities persisted. Mortality rates remained consistently higher in the Southern region and lowest in the Northeast, which showed the greatest reduction over time (AAPC, −4.23%; 95% CI, −5.31 to −3.13).

Non-Hispanic Black women experienced persistently higher mortality compared with other racial and ethnic groups, and women residing in nonmetropolitan areas had elevated mortality rates. Considerable geographic variation was observed across states, with mortality rates in higher-burden states approximately two- to four-fold higher than those in lower-burden states. Sensitivity analyses restricted to women aged ≥25 years confirmed consistent long-term mortality trends between bridged-race and corrected single-race estimates.

No evidence of an accelerated decline around 2019/2020 was identified, and the previously reported post-2019 acceleration was attributable to inconsistent age restrictions during data extraction rather than a true epidemiological change.</p>Conclusion<p>Although cervical cancer mortality has declined significantly in the United States over the past two decades, substantial socio-demographic and geographic disparities persist.

These findings highlight the need for targeted public health strategies to improve equitable access to screening, HPV vaccination, and timely treatment, particularly in high-risk populations and underserved regions.</p>