Cervical cancer is one of the main causes of cancer-related death among women in Brazil, with the greatest impact in the North and Northeast regions. Persistent infection with human papillomavirus (HPV), especially types 16 and 18, is the main etiological factor. Although the country has offered free vaccination since 2014, coverage remains below the 90% target established by the World Health Organization (WHO). This ecological study seeks to assess the association between HPV vaccination coverage and cervical cancer mortality rates in Brazil. Ecological study using public data obtained from DATASUS and the Programa Nacional de Imunizações, covering the period from 2014 to 2022. The unit of analysis was the Brazilian region (North, Northeast, Southeast, South and Center-West). Annual mortality rates from cervical cancer (ICD-10 C53) per 100,000 women and vaccination coverage rates for two doses of the quadrivalent HPV vaccine were collected. Descriptive analysis of variables and correlation between vaccination coverage and mortality rates by region over time were performed. The analysis revealed significant regional disparities. In 2022, the South and Southeast regions showed average vaccination coverage above 75%, with a downward trend in cervical cancer mortality rates. In the South, mortality declined from 5.8 to 4.3/100,000 between 2014 and 2022. In the North and Northeast, coverage ranged from 55% to 65%, and mortality rates remained high, above 7.0/100,000 women, with increases in some states such as Amazonas and Maranhão. An inverse correlation was observed between vaccination coverage and mortality ( r = -0.61), suggesting that higher vaccination rates may be associated with reduced mortality. Inequality in HPV vaccination coverage among Brazilian regions reflects structural disparities in access to health, education and prevention. Regions with higher coverage showed more consistent declines in cervical cancer mortality, demonstrating the effectiveness of vaccination. In contrast, persistently high rates in the North and Northeast indicate the urgent need to strengthen campaigns, logistics and health education. Although ecological studies do not establish causality, they provide relevant evidence on the benefits of vaccination and highlight the importance of surveillance to guide public policies.
Stocki et al. (Sun,) studied this question.