Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Linda M. Niccolai

Second Advisor

Daniel M. Weinberger


Introduction: HPV is necessary for the development of invasive cervical cancer. There were 530,000 cases and 275,000 deaths attributable to cervical cancer in 2008. Since the introduction of HPV vaccines in 2006, the incidence of high grade cervical lesions (HGCL)—precancerous lesions which may develop into cervical cancer—has decreased significantly. Some changing sociodemographic trends in disease burden have been previously reported since 2008.

Objectives: The objectives of this analysis were to identify regions of Connecticut with high rates of HGCLs and to describe how trends of disease changed over time in the post-vaccine era.

Methods: This is a descriptive analysis of surveillance data on HGCLs that were collected from all 34 state pathology laboratories between 2008 and 2013 through the HPV-IMPACT surveillance project. Spatial analyses were performed to identify clusters of high rates of HGCLs in 20-39 and 20-24 year old groups. Census sociodemographic data were linked to clusters to analyze trends in disease burden. A Poisson regression model was fit to describe the changing statewide patterns of disease in different racial, ethnic, socioeconomic, and age groups.

Results: Spatial analyses identified several transient clusters of HGCLs from 2008 to 2013. These clusters varied in size, racial, ethnic, and socioeconomic composition. A persistent cluster of HGCLs was observed in the northwestern region of the state across age groups. The number of cases declined significantly from 2009 to 2013 in the 20-24 and 25-29 year old groups, but did not change significantly in the 30-39 year old groups. Census tracts with ≥20% in poverty had a significantly lower rate of cases compared to census tracts with <5% in poverty. These same census tracts had a higher rate of cases in the 30-34 and 35-39 year old group compared to census tracts with <5% in poverty. No significant interactions between poverty level and time were observed in predicting the number of cases in any age strata between 20 and 39 years old.

Discussion: Local public health collaborators should further investigate the persistent cluster of HGCLs in the northwestern region of the state. Cases have been declining consistently since the introduction of the vaccine in younger age groups (20-29) which may be affected by the vaccine. This decline was not seen in older groups (30-39) that likely did not receive the vaccine. This method of linking surveillance data to census data with spatio-temporal analysis can be used in other areas to assess changing trends in precancerous lesions in the post-vaccine era.


This is an Open Access Thesis.