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Sociodemographic Factors Associated With High-Risk Human Papillomavirus Infection

From the ¹Division of Adolescent Medicine, ²Center for Epidemiology and Biostatistics, and ³Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio.

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

LEVEL OF EVIDENCE: III

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