title: Sociodemographic factors associated with high-risk human papillomavirus infection.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Adolescent Medicine, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. Jessica.kahn@cchmc.org
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Kahn
authors.forename: Dongmei
authors.initials: D
authors.lastname: Lan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D000328:Adult; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D053918:Papillomavirus Vaccines / Q000627:therapeutic use; D011203:Poverty; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D053918:Papillomavirus Vaccines