Global Trends and Disparities in Cervical Cancer Control in Central Asia (1990-2023): A Comparative Age-Period-Cohort and Joinpoint Regression Analysis.

Abstract

Background: Cervical cancer is a significant public health challenge that remains a leading cause of premature death among women in Central Asia, serving as a marker of health inequality. Following the dissolution of the Soviet Union, healthcare strategies diverged, creating disparate outcomes for women across the region. This study evaluates the long-term trends in cervical cancer incidence, mortality, and disability-adjusted life years (DALYs) across Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, distinguishing between the life-saving potential of organized screening and the limitations of opportunistic approaches.

Methods: We conducted a comparative ecological study using the Global Burden of Disease (GBD) Study 2023 dataset (1990-2023). We analyzed trends in Age-Standardized Rates (ASR) and the absolute human burden of disease. Joinpoint regression was used to calculate the Average Annual Percent Change (AAPC). An Age-Period-Cohort (APC) model (intrinsic estimator) was employed to isolate "period effects" attributable to screening interventions from demographic and cohort factors. Ovarian cancer served as a descriptive comparative reference to contrast trends with another gynecological malignancy that lacks an organized population-based screening programme in the region.

Results: Kazakhstan demonstrated a robust decline in mortality (ASR AAPC: -2.5%; 95% CI: -2.8 to -2.2), associated with a strong period effect following the scale-up of its organized national screening programme. In contrast, neighboring countries exhibited slower declines and face a critical demographic divergence (the 'scissors effect'): while statistical rates have stabilized, the absolute number of lives lost has nearly doubled since 1990 due to population growth. Furthermore, the disease affects women in the region at a younger age than the global average, amplifying the socioeconomic loss.

Conclusion: A widening gap in cancer control exists within Central Asia. Kazakhstan's experience indicates organized screening reduces mortality. To ensure regional health equity, neighboring countries must urgently transition to organized national programmes. This may be accelerated by adopting, technology-driven solutions like Artificial Intelligence (AI) to bridge resource gaps in underserved communities.