Evaluating Intersectional Variation of HPV-Associated Cancers in Rural America

Purpose: For decades, incidence of human papillomavirus (HPV)-associated cancers has been increasing in rural communities across the United States. Although emerging evidence shows a widening rural-urban disparity, rural intersectionality has been understudied. Our study examined the incidence of HPV-associated cancers within rural communities to identify differences by race/ethnicity for males and females, and explore how these differences varied by cancer type, socioeconomic, and geographic factors. Methods: We accessed age-adjusted cancer incidence rates (2010-2019) from the North American Association of Central Cancer Registries (NAACCR) for HPV-associated cancers (cervical, vaginal, vulvar, penile, anal, oropharyngeal) in rural counties. Stratifying by sex, we calculated incidence rate ratios by race/ethnicity. Subgroup analyses included age, site, census-tract poverty, census tract socioeconomics, and region. Results: Between 2010-2019, rural HPV-associated cancer was 11.8 cases per 100,000 population. We found significant heterogeneity within male (10.5) and female (13.2) rates. For males, the lowest rate was found in non-Hispanic Asian-American/Pacific-Islander populations (3.7) and Hispanic populations (4.8), and the highest rate was found in non-Hispanic White populations (11.2). For females, the lowest rate was also found in Hispanic Asian-American/Pacific-Islander populations (8.8) and the highest rates were found in non-Hispanic Black (13.8) and non-Hispanic American Indian/Alaska Native populations (14.5). However, these racial/ethnic differences varied across rural subpopulations, geography, and poverty. Conclusions: Appreciating the diversity of the rural cancer burden can be used to effectively develop and implement public health interventions to address HPV-related cancer disparities in rural communities. Actions are needed to prioritize reducing the burden of HPV-associated cancer in AIAN populations in high-poverty rural communities.