Monica M Brackney1, Daniel M Weinberger2, Kyle Higgins1, James Meek1, Linda M Niccolai1,2. 1. 272499 Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA. 2. 50296 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Abstract
OBJECTIVES: Trends in the incidence of precancerous cervical lesions can be monitored to evaluate the impact of human papillomavirus (HPV) vaccination. The objective of this analysis was to determine whether declines in precancerous cervical lesions varied by area-based measures of poverty, race, and ethnicity. METHODS: We analyzed 11 years of incidence data (2008-2018) from a statewide active surveillance system of precancerous cervical lesions in Connecticut. We divided area-based measures of poverty, race, and ethnicity (percentage of the population in a census tract who were living below the federal poverty level, who were Black, and who were Hispanic) at the census-tract level into 4 groups (<5.0%, 5.0%-9.9%, 10.0%-19.9%, ≥20.0%) using recommended cut points from the Public Health Disparities Geocoding Project. We estimated incidence rates and average annual percentage changes (AAPCs) stratified by age and each area-based measure using Joinpoint regression software. We used total population and estimated screened population as denominators for each age group to calculate rates and AAPCs. RESULTS: During 2008-2018 in Connecticut, 18 878 women aged 21-39 were diagnosed with precancerous cervical lesions. After adjusting for screening, the largest declines occurred among women aged 21-24 (AAPC = -11.5%; 95% CI, -13.6% to -9.4%). We found significant and similar annual declines (~10%-12%) in this age group across all 4 levels of poverty, race, and ethnicity. CONCLUSIONS: This analysis adds to the growing body of evidence demonstrating the positive impact of population-level HPV vaccination among young women that appears similar across area-based measures of sociodemographic characteristics. Monitoring is necessary to ensure the continuation of this progress in all communities.
OBJECTIVES: Trends in the incidence of precancerous cervical lesions can be monitored to evaluate the impact of human papillomavirus (HPV) vaccination. The objective of this analysis was to determine whether declines in precancerous cervical lesions varied by area-based measures of poverty, race, and ethnicity. METHODS: We analyzed 11 years of incidence data (2008-2018) from a statewide active surveillance system of precancerous cervical lesions in Connecticut. We divided area-based measures of poverty, race, and ethnicity (percentage of the population in a census tract who were living below the federal poverty level, who were Black, and who were Hispanic) at the census-tract level into 4 groups (<5.0%, 5.0%-9.9%, 10.0%-19.9%, ≥20.0%) using recommended cut points from the Public Health Disparities Geocoding Project. We estimated incidence rates and average annual percentage changes (AAPCs) stratified by age and each area-based measure using Joinpoint regression software. We used total population and estimated screened population as denominators for each age group to calculate rates and AAPCs. RESULTS: During 2008-2018 in Connecticut, 18 878 women aged 21-39 were diagnosed with precancerous cervical lesions. After adjusting for screening, the largest declines occurred among women aged 21-24 (AAPC = -11.5%; 95% CI, -13.6% to -9.4%). We found significant and similar annual declines (~10%-12%) in this age group across all 4 levels of poverty, race, and ethnicity. CONCLUSIONS: This analysis adds to the growing body of evidence demonstrating the positive impact of population-level HPV vaccination among young women that appears similar across area-based measures of sociodemographic characteristics. Monitoring is necessary to ensure the continuation of this progress in all communities.
Authors: Nancy Krieger; Pamela D Waterman; Jarvis T Chen; Mah-Jabeen Soobader; S V Subramanian Journal: Public Health Rep Date: 2003 May-Jun Impact factor: 2.792
Authors: Debbie Saslow; Diane Solomon; Herschel W Lawson; Maureen Killackey; Shalini L Kulasingam; Joanna Cain; Francisco A R Garcia; Ann T Moriarty; Alan G Waxman; David C Wilbur; Nicolas Wentzensen; Levi S Downs; Mark Spitzer; Anna-Barbara Moscicki; Eduardo L Franco; Mark H Stoler; Mark Schiffman; Philip E Castle; Evan R Myers Journal: CA Cancer J Clin Date: 2012-03-14 Impact factor: 508.702
Authors: Julia Warner Gargano; Ina U Park; Marie R Griffin; Linda M Niccolai; Melissa Powell; Nancy M Bennett; Michelle L Johnson Jones; Erin Whitney; Manideepthi Pemmaraju; Monica Brackney; Nasreen Abdullah; Mary Scahill; Rebecca M Dahl; Angela A Cleveland; Elizabeth R Unger; Lauri E Markowitz Journal: Clin Infect Dis Date: 2019-04-08 Impact factor: 9.079
Authors: Nancy Krieger; Jarvis T Chen; Pamela D Waterman; David H Rehkopf; S V Subramanian Journal: Am J Public Health Date: 2005-02 Impact factor: 9.308
Authors: Linda M Niccolai; James I Meek; Monica Brackney; James L Hadler; Lynn E Sosa; Daniel M Weinberger Journal: Clin Infect Dis Date: 2017-09-15 Impact factor: 9.079
Authors: Limin X Clegg; Marsha E Reichman; Barry A Miller; Benjamin F Hankey; Gopal K Singh; Yi Dan Lin; Marc T Goodman; Charles F Lynch; Stephen M Schwartz; Vivien W Chen; Leslie Bernstein; Scarlett L Gomez; John J Graff; Charles C Lin; Norman J Johnson; Brenda K Edwards Journal: Cancer Causes Control Date: 2008-11-12 Impact factor: 2.506
Authors: Mohammad A Tabatabai; Jean-Jacques Kengwoung-Keumo; Wayne M Eby; Sejong Bae; Juliette T Guemmegne; Upender Manne; Mona Fouad; Edward E Partridge; Karan P Singh Journal: PLoS One Date: 2014-09-16 Impact factor: 3.240