{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:04:27Z","timestamp":1781532267070,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,5]],"date-time":"2025-01-05T00:00:00Z","timestamp":1736035200000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005345","name":"American Association for Dental, Oral, and Craniofacial Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005345","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Human papillomavirus (HPV) can cause cancers of the genital system, anus\/rectum, and oropharynx. Prior research showed that HPV\u2010associated cancer incidence was rising faster in nonmetro than in metro populations. Our study identified which cancers contributed to the widening disparity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Representing \u223c93% of all cancers in the United States, we analyzed data from the North American Association of Central Cancer Registries (2000\u20102019). Restricting the analysis to HPV\u2010associated cancers, we compared 5\u2010year average age\u2010adjusted incidence rates (per 100,000 population) for nonmetropolitan (Rural\u2010Urban Continuum Codes 4\u20109) and metropolitan populations, by sex and cancer site. To quantify the rural\u2010urban gap, we calculated rate ratios and absolute differences of incidence trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Although incidence was similar in 2000\u20102004 (nonmetropolitan = 9.9; metropolitan = 9.9), incidence in 2015\u20102019 was significantly higher in nonmetropolitan (12.3) than metropolitan (11.1) populations. The gap was widest for cervical cancers (females) in 2015\u20102019 (1.0 case per 100,000) but grew the most since 2000\u20102004 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\u20102019 were higher than the respective RRs for all other years. Since 2000, the nonmetropolitan disparity has significantly grown for anal and cervical cancers in females, and oropharyngeal cancers in both sexes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Although preventable, nonmetropolitan Americans have shouldered a growing burden of HPV\u2010associated cancers. To address these cervical, anal, and oropharyngeal cancer disparities, it is imperative that HPV vaccination programs are effectively implemented at scale.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.12915","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:54:14Z","timestamp":1736124854000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["What cancers explain the growing rural\u2010urban gap in human papillomavirus\u2010associated cancer incidence?"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0375-8090","authenticated-orcid":false,"given":"Jason","family":"Semprini","sequence":"first","affiliation":[{"name":"Department of Public Health Des Moines University College of Health Sciences  West Des Moines Iowa USA"},{"name":"University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5174-8666","authenticated-orcid":false,"given":"Whitney","family":"Zahnd","sequence":"additional","affiliation":[{"name":"University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather M.","family":"Brandt","sequence":"additional","affiliation":[{"name":"St. Jude Children's Hospital  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,5]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"GarciaMR LeslieSW WrayAA.Sexually Transmitted Infections [Internet]. 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