Background: Near elimination of cervical cancer in the United States is possible in coming decades, yet inequities will delay this achievement for some populations. We sought to explore the effects of human papillomavirus (HPV) vaccination on disparities in cervical cancer incidence between high- and low-poverty U.S. counties. Methods: We calibrated a dynamic simulation model of HPV infection to reflect average counties in the highest and lowest quartile of poverty (percent of population below federal poverty level), incorporating data on HPV prevalence, cervical cancer screening, and HPV vaccination. We projected cervical cancer incidence through 2070, estimated absolute and relative disparities in incident cervical cancer for high- versus low-poverty counties, and compared incidence with the near-elimination target (4 cases/100,000 women annually). Results: We estimated that, on average, low-poverty counties will achieve near-elimination targets 14 years earlier than high-poverty counties (2029 vs. 2043). Absolute disparities by county poverty will decrease, but relative differences are estimated to increase. We estimate 21,604 cumulative excess cervical cancer cases in high-poverty counties over the next 50 years. Increasing HPV vaccine coverage nationally to the Healthy People 2020 goal (80%) would reduce excess cancer cases, but not alter estimated time to reach the near-elimination threshold. Conclusions: High-poverty U.S. counties will likely be delayed in achieving near-elimination targets for cervical cancer and as a result will experience thousands of potentially preventable cancers. Impact: Alongside vaccination efforts, it is important to address the role of social determinants and health care access in driving persistent inequities by area poverty.

中文翻译：

---

减少宫颈癌中与贫困相关的差异：HPV 疫苗接种的作用

背景：在未来几十年内，美国几乎可以消除宫颈癌，但对于某些人群来说，不平等将推迟这一成就。我们试图探索人乳头瘤病毒 (HPV) 疫苗接种对美国高贫困县和低贫困县宫颈癌发病率差异的影响。方法：我们校准了 HPV 感染的动态模拟模型，以反映贫困最高和最低四分位数的平均县（低于联邦贫困线的人口百分比），并结合了 HPV 患病率、宫颈癌筛查和 HPV 疫苗接种的数据。我们预测到 2070 年的宫颈癌发病率，估计高贫困县与低贫困县发生宫颈癌的绝对和相对差异，并将发病率与接近消除的目标（4 例/100，000 名女性）。结果：我们估计，平均而言，低贫困县将比高贫困县提前 14 年实现接近消除的目标（2029 年与 2043 年）。县贫困的绝对差异将减少，但估计相对差异会增加。我们估计未来 50 年高贫困县将有 21,604 例累积超额宫颈癌病例。在全国范围内将 HPV 疫苗覆盖率提高到 2020 年健康人的目标（80%）将减少过多的癌症病例，但不会改变达到接近消除阈值的估计时间。结论：美国的高贫困县可能会延迟实现几乎消除宫颈癌的目标，因此将出现数千种可能可预防的癌症。影响：除了疫苗接种工作，