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Human Papillomavirus Prevalence Is Associated With Socioeconomic Gradients Within a Medically Underserved Appalachian Region

Ware, S. Lee MD*; Crosby, Richard PhD†‡§; Fisher, Rebecca PhD; Hagensee, Michael E. MD, PhD

doi: 10.1097/OLQ.0000000000000675
Original Studies

Objectives: To assess type-specific prevalence of human papillomavirus (HPV) infection in a medically underserved Appalachian area and to determine whether gradients in poverty are associated with prevalence.

Methods: Among 398 women, a validated assay tested self-collected cervicovaginal samples for 37 HPV types. Three economic strata were created based on household income: below the federal poverty level for 1 person, between the FPLs for families of 1 to 4 persons, and above the FPL for a family of 4.

Results: Prevalence was 55.6%, with 33% having at least 1 high-risk infection. Prevalence was 27.8% for 9-valent HPV vaccine–preventable types and 39.2% for multiple types. Compared with FPL for a family of 4, women with federal poverty level for 1 person had 3 times greater prevalence, 2.3 times greater prevalence of high-risk types, and 2.5 times greater prevalence of multiple types.

Conclusion: Human papillomavirus prevalence was high, with one-third of the sample having at least 1 high-risk type and those in the lowest-income category being disproportionately infected.

Among a rural population of cotesting-aged women, high-risk human papillomavirus infections were common. The lowest level of socioeconomic status was a robust predictor of infection.

From the Colleges of *Medicine and †Public Health, University of Kentucky, Lexington, KY; ‡Kinsey Institute for Research in Sex, Gender, and Reproduction, Bloomington, IN; §University of Mississippi Medical Center, Jackson, MS; ¶Stanley S. Scott Cancer Center and ∥Departments of Medicine and Microbiology, Louisiana State University Health Sciences Center, New Orleans, LA

Conflicts of Interest: No conflicts of interest exist.

Funding: This project was supported by Cooperative Agreement No. 1U48DP001932-01 from the Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Correspondence: Richard Crosby, PhD, College of Public Health, 151 Washington Ave, Lexington, KY 40506-0003. E-mail:

Received for publication April 6, 2017, and accepted June 3, 2017.

© Copyright 2017 American Sexually Transmitted Diseases Association