| ObjectivesThe purpose of this study was to investigate the Human papillomavirus(HPV)infection and risk factors of cervical cancer and cervical intraepithelial neoplasia(CIN)in Jinyun and Jingning,Lishui City,Zhejiang Province,China,and to provide scientific basis for formulating regional prevention and control strategies.MethodsThis study adopted a cross-sectional research method and recruited 3,000 eligible rural women aged 21-64 in Jinyun County and Jingning County,Lishui City,Zhejiang Province.All subjects underwent questionnaire survey and cervical cancer screening(including HPV testing and cytology testing).The questionnaire results,HPV test results and pathological grading results were collected.SAS9.4 software was used for data analysis.All analyzes were two-sided,with α=0.05 as the test level.Enumeration data were expressed by frequency and composition ratio(%),and the comparison between groups was performed byχ 2 test.A binary Logistic regression model was used to analyze behavioral factors(including the age of the subjects,education status,age of menarche,age of first pregnancy,age of first birth,number of pregnancies,times of delivery,contraceptive measures,smoking history,drinking history)and the relationship between HPV infection and CIN2+.Results1.Demographic3195 subjects were screened,and 3125 subjects enrolled to this study and provided completed questionnaire and cervical screening test at baseline.The average age of enrolled subjects is 45.62±8.02 years old,the youngest was 21 years old,and the oldest was 64 years old.Subjects aging over 35 accounted for 88.4%(N=2763)of all enrolled subjects,most of them were married(98.7%);61.3%had an education level of junior high school or below.2.HPV infection rateThe HPV infection rate was defined as the percentage of any type of HPV positive in all subjects.The positive rate of HPV was 14.8%(462/3125),which is higher than the reported HPV positive rate of 9.91%comparing to domestic research of 30 provinces in 2018.The infection rate of HPV 16 was 2.1%,and that of HPV 18 was 1.2%.The positive rate of HPV increased with age,and there were differences among different age groups with P<0.05.The groups with higher HPV infection rate were the 26-30 age group and the 5164 age group.3.CIN2+ detection rateThe prevalence of cervical intraepithelial neoplasia was defined as the percentage of CIN pathological grade 2 and above(CIN2+)in all subjects.At baseline,40 people were CIN2+,accounting for 1280/100,000(1.28%)of 3125 subjects,which is higher than the reported 398.42/100,000 comparing to domestic research of 30 provinces from 2015 to 2018.100%of the baseline CIN2+subjects were HPV positive,among whom the positive rate of HPV16 was 40%(16/40),HPV16 and/or 18 positive was 52.5%(21/40),and other types of HPV was 47.5%(19/40).Compared with domestic studies,the overall HPV positive rate among CIN2+patients is higher than the rate reported in 2000-2019 which is 87%,and the HPV 16 detection rate is slightly lower than the reported.45.69%.4.Risk factors for cervical cancer and CIN2+The results of binary logistic regression analysis showed that HPV 16/18 infection was a risk factor for CIN2+(OR=46.1,95%CI:21.9～4.702;P<0.0001);The risk of CIN2+in women who use intrauterine device contraception was 2.42 times that of women taking other contraceptive measures(95%CI:1.14-5.14;P=0.0209).Likelihood ratio testχ2=23.9854,P<0.0001,indicating that the model is statistically significant.The area under the ROC curve corresponding to the model is 0.8131,indicating the model has certain accuracy.ConclusionsThe HPV infection rate in Lishui City,Zhejiang Province was 14.8%,and the prevalence rate of CIN2+was 1280/100,000(1.28%),both are higher than the reported rate of 9.91%and 398.42/100,000 in other domestic regions.The biggest risk factor for CIN2+is HPV 16 and/or 18 infection,and secondly,CIN2+is related to the use of IUD by local women as a contraceptive measure. |
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