Risk of cervical cancer and high-grade lesions in vulnerable women a systematic review and meta-analysis

Cervical cancer is largely preventable, yet causes around 300,000 deaths annually, disproportionately affecting vulnerable women. In here, we aim to estimate the risk of high-grade cervical lesions and cervical cancer among vulnerable populations in high- and upper-middle-income countries. We conduct a systematic review and meta-analysis of studies published up to February 2024 (from 2004 for HIV) across four databases. Risk of bias is assessed using the Newcastle-Ottawa Scale. We include women with low socioeconomic status, migrants, prisoners, sex workers, women with substance use disorders, mental illness, and living with HIV. The primary outcome is the pooled risk of cervical cancer and high-grade lesions; the secondary outcome is subgroup-specific risk. The analysis focuses on biologically defined females, with sex determined by author reporting. In this work, based on 127 studies, we show that vulnerable women face higher risks of cervical cancer (RR2.78; 95%CI 2.32-3.32) and high-grade lesions (RR 2.5; 95%CI 2.05-3.04), with high heterogeneity supporting equity-focused prevention strategies.