Kahn Jessica A, Lan Dongmei, Kahn Robert S
Division of Adolescent Medicine, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Obstet Gynecol. 2007 Jul;110(1):87-95. doi: 10.1097/01.AOG.0000266984.23445.9c.
To determine the prevalence of high-risk (cancer-associated) human papillomavirus (HPV) infection in U.S. women, identify sociodemographic factors associated with infection, and explore the implications for prevention of HPV-related disease in the vaccination era.
Women aged 14-59 years (n=1,921) participating in the 2003-2004 National Health and Nutrition Examination Survey provided a vaginal swab which was evaluated for 37 HPV types. We determined which sociodemographic characteristics were associated with high-risk HPV, using logistic regression models.
High-risk HPV infection was present in 15.6% (95% confidence interval [CI] 12.6-18.6%) of participants, corresponding to a population prevalence of 12,028,293 U.S. women. Women living below the poverty line, compared with those living three or more times above it, were more likely to be positive for high-risk HPV (23% versus 12%, P = .03). Among participants living below the poverty line, only Mexican-American ethnicity (odds ratio [OR] 0.4, 95% CI 0.2-0.9) and unmarried status (OR 3.3, 95% CI 1.2-8.9) were associated with HPV prevalence. In contrast, several factors were associated with HPV among participants living above the poverty line, including black race (OR 1.4, 95% CI 1.0-2.0), income (OR 0.92, 95% CI 0.84-0.99), unmarried status (OR 2.0, 95% CI 1.3-3.0), and age (OR for 22-25 year olds 2.4, 95% CI 1.4-4.0).
High-risk HPV infection is common in U.S. women, particularly in poor women. Cervical cancer prevention efforts in the vaccination era must ensure that all low-income women have access to preventive services including education, Pap test screening, and HPV vaccines. Otherwise, existing disparities in cervical cancer could worsen.
确定美国女性中高危（与癌症相关）人乳头瘤病毒（HPV）感染的患病率，识别与感染相关的社会人口学因素，并探讨在疫苗接种时代预防HPV相关疾病的意义。
参与2003 - 2004年国家健康与营养检查调查的14至59岁女性（n = 1921）提供了阴道拭子，对37种HPV类型进行了评估。我们使用逻辑回归模型确定哪些社会人口学特征与高危HPV相关。
15.6%（95%置信区间[CI] 12.6 - 18.6%）的参与者存在高危HPV感染，相当于美国有12,028,293名女性感染。生活在贫困线以下的女性与生活在贫困线三倍及以上的女性相比，高危HPV检测呈阳性的可能性更高（23%对12%，P = 0.03）。在生活在贫困线以下的参与者中，只有墨西哥裔美国人种族（优势比[OR] 0.4，95% CI 0.2 - 0.9）和未婚状态（OR 3.3，95% CI 1.2 - 8.9）与HPV患病率相关。相比之下，在生活在贫困线以上的参与者中，有几个因素与HPV相关，包括黑人种族（OR 1.4，95% CI 1.0 - 2.0）、收入（OR 0.92，95% CI 0.84 - 0.99）、未婚状态（OR 2.0，95% CI 1.3 - 3.0）和年龄（22 - 25岁人群的OR为2.4，95% CI 1.4 - 4.0）。
高危HPV感染在美国女性中很常见，尤其是贫困女性。在疫苗接种时代，宫颈癌预防工作必须确保所有低收入女性都能获得包括教育、巴氏试验筛查和HPV疫苗在内的预防服务。否则，现有的宫颈癌差异可能会加剧。
