title: Ecological Association of Human Papillomavirus Vaccination with Cervical Dysplasia Prevalence in the United States, 2007-2014.
abstract: OBJECTIVE
  To examine prevalence of low- and high-grade cervical lesions over time in a large cohort of US female adolescents and women.
  
  
  METHODS
  We used health care claims data from 9 million privately insured female patients aged 15 to 39 years to estimate annual prevalence of cytologically detected cervical low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and high-grade histologically detected cervical intraepithelial neoplasia grades 2 and 3 (CIN2+) during 2007 through 2014. We restricted analyses to those who received cervical cancer screening in a given calendar year.
  
  
  RESULTS
  Prevalence of HSIL and CIN2+ decreased significantly for those aged 15 to 19 years. Average annual percent change in prevalence in this group during 2007 through 2014 for HSIL and CIN2+ was -8.3% and -14.4%, respectively (P < .001 for both estimates). Prevalence of HSIL and CIN2+ also decreased significantly for women aged 20 to 24 years. No decreases were seen in women aged 25 to 39 years.
  
  
  CONCLUSIONS
  Decreases in high-grade lesions reflected their greater association with human papillomavirus types 16 and 18, compared with low-grade lesions, providing ecological evidence of population effectiveness of human papillomavirus vaccination among young, privately insured women.
authors.affiliation: At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA.
authors.forename: Elaine W
authors.initials: EW
authors.lastname: Flagg
authors.affiliation: At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Torrone
authors.affiliation: At the time of the study, all of the authors were with the Division of STD Prevention; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Centers for Disease Control and Prevention; Atlanta, GA.
authors.forename: Hillard
authors.initials: H
authors.lastname: Weinstock
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D030361:Papillomavirus Infections / Q000517:prevention & control*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology*; D014611:Vaccination; D055815:Young Adult