What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence? - Brief report

Sep 23, 2026

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Human papillomavirus (HPV) can lead to cancers of the genital system, anus/rectum, and oropharynx. Prior findings showed faster increases in HPV-associated cancer incidence in nonmetro than metro populations. Using North American Association of Central Cancer Registries data from 2000–2019, the study isolates which cancer sites drove the widening rural–urban disparity by comparing age-adjusted incidence trends across sexes and locations.

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DOI: 10.1111/jrh.12915 BRIEF R EPORT What cancers explain the growing rural-urban gap in human papillomavirus-associated cancer incidence? Jason Semprini PhD, MPP1, 2 Whitney Zahnd PhD2 Heather M. Brandt PhD3 1 Department of Public Health, Des Moines University College of Health Sciences, West Des Moines, Iowa, USA 2 University of Iowa College of Public Health, Iowa City, Iowa, USA 3St. Jude Children’s Hospital, Memphis, Tennessee, USA Correspondence Jason Semprini, Department of Public Health, Des Moines University College of Health Sciences, 8025 GrandAve, West Des Moines, IA 50266. [Email:](Email: jsemprini@dmu.edu)[ jsemprini@dmu.edu](Email: jsemprini@dmu.edu) Funding information American Lebanese and Syrian Associated Charities (ALSAC) of St. Jude Children’s Research Hospital; National Cancer Institute; American Association for Dental, Oral, and Craniofacial Research Abstract Purpose: Human 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. Methods: Representing ∼ 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 ageadjusted 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. Results: Although 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 analand 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. KEYWORDS cancer, disparities, HPV, vaccine This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2025 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association. J Rural Health. 2025;41:e12915. [https://doi.org/10.1111/jrh.12915](https://doi.org/10.1111/jrh.12915) wi[leyonlinelibrary.com/journal/jrh](leyonlinelibrary.com/journal/jrh) 1of7 GROWING RURAL-URBAN GAP INTRODUCTION In the United States, human papillomavirus (HPV) is extremely prevalent and is the most common sexually transmitted infection.1 Fourteen million new cases of HPV are reported each year, with an estimated lifetime prevalence exceeding 80% of all sexually active people. 1,2 Some subtypes of HPV can cancers of the genital system in females (cervical, vagina, vulvar) and males (penile), as well as some types of oropharyngeal, anal, and rectum cancers in both sexes.3 HPV, and, therefore, at least 90% of these HPV-associated (HPVa) cancers, can be prevented with on-time HPV vac

FAQs

Which cancer types contributed most to the rural–urban gap in HPV-associated cancer incidence?

The study found the gap was widest for cervical cancers among females in 2015–2019, while oropharyngeal cancers among males showed the largest growth since 2000–2004.

What data and time period were used to assess incidence trends?

Researchers analyzed North American Association of Central Cancer Registries public use data covering HPV-associated cancers diagnosed from 2000 to 2019, excluding 2020.

How did the study measure the rural–urban disparity?

It compared 5-year average age-adjusted incidence rates (per 100,000) for nonmetropolitan (RUCC 4–9) versus metropolitan (RUCC 1–3) populations and quantified differences using rate ratios and absolute differences over time.

Sep 23, 2026

Uploaded by Logic