Deanna S. Fink (United States of America)

California Emerging Infections Program HPV-Impact

Presenter of 1 Presentation

Public Health / Epidemiology / Other Public Health/Epidemiology Research ePoster

AGE-STANDARDIZED HIGH-GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN2+) INCIDENCE RATES BY AREA-BASED SOCIOECONOMIC MEASURES, ALAMEDA COUNTY, CALIFORNIA, UNITED STATES, 2008-2017 (ID 127)

Session Date
07/21/2020
Session Time
10:00 - 17:00
Room
ePoster
Session Type
Poster Viewing - 20-24 July
Session Name
Public Health / Epidemiology / Other Public Health/Epidemiology Research
Lecture Time
10:45 - 10:46

Abstract

Introduction

Little is known about variations in CIN2+ incidence by socioeconomic status. Evaluating cervical disease by area-based socioeconomic measures may facilitate a broader understanding of CIN2+ incidence, particularly when individual-level data are not available. We analyzed age-standardized CIN2+ incidence rates by area-based measures of income, education, and nativity during two 5-year periods (2008-2012, 2013-2017) following introduction of HPV vaccine, in Alameda County (population 1.7 million), a diverse urban area in California with large Asian and Latina foreign-born populations.

Methods

Geocoded data for census tracts in Alameda County were analyzed from population-based surveillance of CIN2+ (HPV-IMPACT), 2008-2017. We obtained denominators and data on median household income, percent without a high school diploma, percent living under federal poverty level, and percent foreign-born from American Community Surveys. Case counts within census tracts were aggregated across area-based measure strata and age groups (18-24, 25-29, 30-34, 35-39, 40+). Strata were compared using age-standardized incidence rate ratios.

Results

In 2008-2012, CIN2+ incidence was significantly higher for census tracts in the lowest income tier compared to those in the highest tier (Figure 1). In 2013-2017, CIN2+ incidence was significantly higher for tracts in the two lowest income tiers compared to the highest, and the two highest poverty tiers compared with the lowest. In both time periods, tracts with the lowest percentages of high school graduates had the highest CIN2+ incidence, and tracts with the highest percentage of foreign-born residents had the lowest CIN2+ incidence.

Conclusions

We found a persistent inverse association between level of education and income with CIN2+ incidence during the HPV vaccination era, similar to the associations observed in studies of HPV prevalence. The unexpected finding of lower incidence in areas with more foreign-born residents merits further evaluation of possible barriers in accessing cervical cancer screening, risk or protective cultural factors, race/ethnicity and country of origin.

figure 1_irrs by absm_fink.jpg

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