Risk factors for cervical cytological abnormalities among women infected with non-16/18 high-risk human papillomavirus (Preprint)

UNSTRUCTURED Objective: The increasing prevalence of non-16/18 high-risk human papillomavirus (hrHPV) infection has recently drawn much attention. Abnormal cytological findings in non-16/18 hrHPV infected women may progress to cervical cancer. We aimed to identify the risk factors for cervical cytological abnormalities among women infected with non-16/18 hrHPV. Methods: A total of 314,587 women had been recruited for cervical cancer screening in Xiangyang city of China from January 2017 to February 2018. Of them, 311,604 women were analyzed for HPV genotyping and 17,523 non-16/18 hrHPV-positive women were further analyzed for cytology. A logistic regression model was conducted to assess risk factors for cytological abnormalities among these non-16/18 hrHPV infected women. Results: The non-16/18 hrHPV infection rate was 5.88% (18,323/311,604), three-fold as the infection rate of hrHPV 16/18 (1.95%, 6,068/311,604). In non-16/18 hrHPV infected women, the prevalence rates of overall cervical cytological abnormalities and high-grade cytological abnormalities were 13.46% and 1.17%. Multivariate logistic regression analysis revealed that women received middle or high school education were at a higher risk of cytological abnormalities than primary education (OR=1.31, 95%CI: 1.17-1.45; OR=1.32, 95%CI: 1.14-1.53). Living in rural areas (OR=2.58, 95%CI: 2.29-2.90), gravidity>=3 (OR=2.77, 95%CI: 1.19-6.45), cervical abnormalities detected on pelvic examination (OR=1.22, 95%CI: 1.11-1.34), and accepting cervical cancer screening over 3 years (OR=0.79, 95%CI: 0.62-1.00) were associated with cytological abnormalities. The risk factors for high-grade cytological abnormalities included middle education (OR=1.45, 95%CI: 1.07-1.98), living in rural regions (OR=1.52, 95%CI: 1.10-2.10) and abnormal cervix (OR=1.72, 95%CI: 1.30-2.26). Conclusion: The dominant epidemic of non-16/18 hrHPV infection is revealed and risk factors have been identified for cervical cytological abnormalities in Chinese women infected with non-16/18 hrHPV. These findings can provide important information for clinically actionable decisions for the implementation of cervical cancer screening program, early diagnosis, monitoring, and intervention.