BACKGROUND: The goal of our study was to examine trends in HPV 16/18-associated cervical lesions by area-based measures of race, ethnicity, and poverty since the introduction of HPV vaccines.
METHODS: All women diagnosed with cervical intraepithelial neoplasia grades 2 and 3 and adenocarcinoma in situ (CIN2+) were reported to a statewide surveillance system in Connecticut. Available specimens were obtained for DNA testing from residents of New Haven County. Women aged 21–39 years during 2008–2014 (n=1,820) were geocoded to census tracts and linked to census tract-based measures of race, ethnicity, and poverty. We tested interactions between year and area-based measures with the outcome of proportion of lesions associated with HPV 16/18 using multivariable logistic regression models that were stratified by age. To illustrate interaction, we graphed the proportion of lesions positive for HPV 16/18 by year and socioeconomic measures.
RESULTS: Among women aged 21–24 years, the proportion of CIN2+ lesions with HPV 16/18 declined from 51% (44/87) in 2008 to 21% (9/42) in 2014. There were significant interactions between year and area-based measures including proportion black (pint=0.038), Hispanic (pint=0.013), and poor residents (pint=0.005). No declines were observed in the older age groups.
CONCLUSIONS: These results suggest that the decline in the proportion of lesions attributed to HPV 16/18 among young women has only occurred in areas with lower proportions of racial and ethnic minorities and persons living in poverty.