Prevalence of human papillomavirus among US females older than recommended age for vaccination by birth cohort, National Health and Nutrition Examination Survey 2003- 2016 Open Access

Vahle, Kristin (Spring 2020)

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Background: Human papillomavirus (HPV) prevalence among population-based samples of females older than recommended vaccination age has not been studied extensively. Understanding prevalences in these ages could be useful context as females eligible for vaccination advance to these ages. Associations between HPV prevalence and age in cross-sectional surveys could be confounded by cohort differences in HPV exposures. We evaluated HPV prevalences by age overall and by birth cohort and evaluated associations between HPV prevalence and characteristics by birth cohort among females 27-59 year born in 1950-1979 from National Health and Nutrition Examination Survey (NHANES) 2003-2016.

Methods: NHANES data from females with adequate HPV typing results from self-collected cervicovaginal swabs were analyzed. Weighted proportions and 95% confidence intervals (CI) of demographic and behavioral characteristics were measured overall and for 1950-1959, 1960-1969, and 1970-1979 birth cohorts. Weighted prevalences and 95% CIs of any HPV, high-risk HPV, and non-high-risk HPV were estimated by 3-year age groups, overall and by birth cohort. Unadjusted and age-adjusted prevalence ratios and 95% CIs for any HPV and characteristics were estimated by birth cohort with log-binomial regression.

Results: Prevalence was 38.5% for any HPV, 18.1% for HR HPV, and 30.6% for non-HR HPV. Significant declines in prevalence were observed per 3-year age increase for any HPV (APC: -2.86%), HR HPV (APC: -6.40%), and non-HR HPV (APC: -2.02%). Adjusting for age, interaction between age and cohort on prevalence was not significant (p-value > 0.05 for all HPV group types). Associations between most characteristics and any HPV were similar in each cohort after adjusting for age.

Conclusions: We found no evidence of a cohort effect on any HPV, HR HPV, and non-HR HPV as the relationship of prevalence and age did not vary by birth cohort. We also found associations between any HPV prevalence and many characteristics, including marital status, age at sexual debut, number of lifetime partners, and others, did not vary by birth cohort controlling for age; only race/ethnicity varied. Lack of a cohort effect on age-specific prevalence suggests that declines in HPV prevalence with age observed in cross-sectional studies are attributable to differences in age rather than cohort.

Table of Contents

Chapter I: Background. 1

Chapter II: 9

Title, Author, Abstract 9

Introduction. 10

Methods. 12

Results 16

Discussion. 20

Strengths and Limitations 23

References 26

Tables. 32

Figures. 36

Chapter III: Summary, Public Health Implications, Possible Future Directions. 41

Appendix I: Sensitivity Analysis 44


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