Abstract

Objective: Despite known state and regional differences, United States (US) county-level patterns of human papillomavirus (HPV)-associated cancer incidence remain unexplored. Methods: In this cross-sectional study, we analyzed US county-level HPV-associated cancer incidence rates from 2008 to 2022 using the US Cancer Statistics Incidence Analytic Database to identify geographic clusters of high and low incidence. Clusters were identified using the Getis-Ord Gi* statistic and assessed for differences in cluster-level sociodemographic characteristics and sex-and-site-specific incidence. Results: We found 373 hot spot and 409 cold spot counties, with median incidence rates of 16.14 and 10.62 per 100,000, respectively. Hot spot counties were particularly concentrated in Central Appalachia, the northern portion of the Mississippi Delta, and northern Florida. Compared to cold spots, hot spot counties were more rural (median, 72.02 % vs. 42.09 %) and had higher poverty (median, 17.71 % vs 10.51 %). The largest disparities between cluster-level incidence rates were observed in oropharyngeal and vulvar cancers, with rates over 60 % higher in hot spot counties than cold spot counties. Conclusion: Our study identified distinct geographic clusters with disproportionately high HPV-associated cancer incidence. These findings highlight areas where intensified prevention and control efforts, including direct vaccination, screening, and outreach efforts, are needed to eliminate HPV-related cancer disparities.

Document Type

Article

Publication Date

2026

Notes/Citation Information

0091-7435/© 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.ypmed.2025.108491

Funding Information

Dr. Burus reports support from National Cancer Institute grant P30CA177558. Drs. Damgacioglu and Deshmukh report support from the National Cancer Institute grant P30CA138313.

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