Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Linda Niccolai

Abstract

Abstract

Background: In 2006, the FDA approved the first vaccine against human papillomavirus. Trends in HPV-related sequalae are an effective method of analyzing HPV vaccine impact. Our primary objective was to measure trends in cervical neoplasia based on sociodemographic characteristics including race, ethnicity, and socioeconomic status.

Methods: Since 2008, Connecticut has required reporting of cervical intraepithelial neoplasia labeled grade 2+ and adenocarcinoma in situ. CIN 2+ diagnoses trends were modeled by area-based measures of age, race, ethnicity, and socioeconomic status using negative binomial regression and change-point analysis. Incidence rate measurements were adjusted to reflect inclusion of women who had completed cervical pap smears.

Results: From 2008-2017 incidence rate of cervical intraepithelial neoplasia per 100,000 person-years declined by 65-85% in 21-26-year-old women. After adjusting by BRFSS data incidence rate declines only remain significant in women ages 21-25 with diagnoses dropping from 30-80%. Significant declines were demonstrated across sociodemographic factors. Women ages 21-24 showed significant declines in CIN 2+ regardless of what percentage of the population in their census tract identified as Black, Latino, or below the federal poverty line. From 2008-2017 the incidence rate of cervical intraepithelial neoplasia per 100,000 person-years declined by 73-76% across all census tracts, regardless of what percentage of the population in their census tract identified as Latino (i.e. less than 5%, 5-10%, 10-20%, and greater than 20%). For area-based measures of racially identifying as Black the decline was 75-77%. Lastly, for area-based measures of identifying as below the federal poverty line the decline was 71-78%. When data was adjusted for screening population using BRFSS data the results were as follows: 66-69% decline in incidence rate of CIN 2+ across area-based measures of racially identifying as Black, 63-68% decline in incidence rate across area-based measures of identifying as Latino, and 62-70% decline in incidence rate across area-based measures of identifying as below the federal poverty line.

Conclusions: Significant declines in CIN+2 diagnoses from 2008-2017 were observed in the overall population and amongst the estimated screened population. These trends are suggestive of declines attributable to HPV vaccination in CT. The significant decline in incidence across different sociodemographic factors, even after stratifying census tracts by the portion of their populations that identify as Black, Latinx, or below the federal poverty line (FPL) demonstrates that vaccine impact is reaching various sociodemographic groups and reduces risk of results confounding by race, ethnicity, and socioeconomic status.

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This is an Open Access Thesis.

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