Journal: Nature communications
This systematic review and meta-analysis examined whether socially and medically vulnerable women in high- and upper-middle-income countries have elevated risks of high-grade cervical lesions and cervical cancer.
Populations included:
- Women with low socioeconomic status
- Migrants
- Prisoners
- Sex workers
- Women with substance use disorders
- Women with mental illness
- Women living with HIV
Methods:
- Searches across four databases for studies up to February 2024 (from 2004 onward for HIV-related studies)
- 127 studies included
- Risk of bias evaluated using the Newcastle–Ottawa Scale
- Analyses restricted to biologically defined females, using sex as reported by study authors
- Primary outcome: pooled risk of cervical cancer and high-grade cervical lesions vs. non-vulnerable comparison groups
- Secondary outcome: risk by specific vulnerable subgroup
Key findings:
- Higher risk of cervical cancer among vulnerable women: Relative risk (RR) 2.78; 95% CI 2.32–3.32
- Higher risk of high-grade cervical lesions: RR 2.50; 95% CI 2.05–3.04
- High heterogeneity across studies, reflecting differences in populations, settings, and methodologies
Clinical and public health implication:
The consistently elevated risks across vulnerable groups support prioritizing equity-focused cervical cancer prevention strategies, including targeted screening, HPV vaccination, and tailored outreach to these populations within otherwise high-resource healthcare systems.