Risk Factors For Cervical Cancer In Rural Areas Of Qingyang,gansu Province:A Case-control Study

Objective: To explore reasons for high-incidence of uterine cervix cancer in rural areas of Qingyang by using case-control method to collect related risk factor information about the occurrence of cervical cancer so as to provide a scientific basis for the establishment of prevention and control systems and the development of prevention and control strategies and measures for cervical cancer.Methods: A 1:2 matched case-control study design was used in this study.Through the new rural cooperative medical insurance information platform in some high-incidence counties(Xifeng District,Zhenyuan County,Huachi County),223 patients who were diagnosed with cervical cancer from January 2014 to March 2017 were selected as the case group.According to the matching principle of age(±3 years)and 1:2 between cases and controls,446 healthy female residents in the patient's place of residence were selected as the control group.The database was established by using Epidata 3.1.The statistical analysis was carried out by SPSS 22.0 software.Descriptive analysis was used to describe the basic situation of each study factors in the case group and the control group;Univariate and multivariate conditional logistic regression models were used to analyze the risk factors of cervical cancer.Otherwise,the population attributable risk of the main risk factors was estimated.Results:(1)223 patients with cervical cancer and 446 controls were included in this study.The age range of cervical cancer patients ranged from 36 to 79 years old,with an average age of 53.18 ± 8.54 years.The age range of the control group was33-79 years old,with an average age of 51.63 ± 9.35 years.(2)Univariate conditional logistic regression results showed that some factors were related to the incidence of cervical cancer such as educational level,occupation,family per capita monthly income,drinking water source,sufficient water in daily life,history of passivesmoking,type of bedding,indoor bathroom,sharing of toilet with others,age of first pregnancy,number of pregnancies,number of vaginal deliveries,history of home delivery,menopause,age of first sexual intercourse,number of sexual partners,cleaning of vulva before and after sexual life and sexual life during menstruation,husband's history of sexually transmitted diseases,husband's number of sexual partners,personality type,emotional regulation ability,experience of unfortunate events in daily life and persistent mental stress.(3)In multivariate analysis,some risk factors were found including farmer(OR vs.Non-farmer women = 3.499),drinking cellar water/pond-ditch water as water source(OR vs.Tap water/Centralized well water = 3.288),not washing their vulva before or after sexual intercourse(OR vs.women who washed their vulva before or after sexual intercourse = 2.425),4 and more pregnancies(OR vs.< 4 pregnancies = 1.680),husband had multiple sexual partners(OR vs.women whose husband had one sexual partner = 2.462),persistent mental stress in daily life(OR vs.women without persistent mental stress = 1.940).At the same time,this study also found that high level income and menopause were protective factors against cervical cancer,OR were 0.545 and 0.490,respectively.(4)Six risk factors for cervical cancer were screened out including peasant occupation,cellar water/pond ditch water,not washing the vulva before or after sexual intercourse,number of pregnancies(? 4 times),husband's number of sexual partners(? 2)and persistent mental stress in daily life.The population attributable risk for each of them was 66.56%,17.79%,26.35%,16.34%,11.45% and 27.38%,respectively.Conclusions: The high incidence of cervical cancer in rural areas of Qingyang is the result of multiple factors;Low socioeconomic status,unsafe water for daily use,unclean sexual life,multiple pregnancies,multiple sexual partners of spouses and persistent mental stress are related to the incidence of cervical cancer in women in this area.It is suggested that comprehensive prevention and control measures should be taken to reduce the incidence of cervical cancer among women in this region.