Does Age Affect the Association between Race/Ethnicity and HPV Screening: A Retrospective Cohort Study of United States Women

95 Does Age Affect the Association between Race/Ethnicity and HPV Screening Marlin and Brunner Huber Journal of Health Disparities Research and Practice Volume 12, Issue 3, Fall 2019, pp. 95-106 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Does Age Affect the Association between Race/Ethnicity and HPV Screening: A Retrospective Cohort Study of United States Women Keila L. Marlin, The University of North Carolina at Charlotte Larissa R. Brunner Huber, The University of North Carolina at Charlotte Corresponding Author: Keila L. Marlin, ABSTRACT Many studies have demonstrated disparities in awareness of and knowledge about human papillomavirus (HPV) among young, immigrant, and minority populations. Yet, there is a lack of existing research that has investigated the role of race/ethnicity and HPV screening, and how it varies by age. The purpose of this study was to evaluate this association using 2016 Behavioral Risk Factor Surveillance System (BRFSS) data. This study included 120,646 women who selfreported information on race/ethnicity, HPV screening, and age. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CIs). A stratified analysis was conducted to determine if age modified the race/ethnicity and HPV screening association. After adjustment, non-Hispanic Black and Multiracial women had statistically significant increased odds of receiving HPV screening as compared to non-Hispanic white women (OR 1.20; 95% CI 1.11, 1.29 and OR 1.58; 95% CI 1.33, 1.88, respectively). There was no association between Hispanic race/ethnicity and HPV screening (OR 1.02; 95% CI 0.95, 1.09). The findings of this study provide evidence that age modifies the association between race/ethnicity and HPV screening. Among the oldest categories of women, non-Hispanic Black, Multiracial, and Hispanic women had increased odds of HPV screening. Conversely, among the youngest categories of women, non-Hispanic Other and Hispanic had decreased odds of HPV screening. Public health interventions and health care providers may need to focus on specific minority subgroups to increase HPV screening in certain sub age categories. Keywords: Human Papillomavirus; HPV Screening; Race/Ethnicity; Age; Women INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (Ford, 2011). Nearly 80 million Americans are infected with at least one strain of HPV; however, not all types of HPV cause cancer (Blake et al., 2015). At least 12 high-risk virus types have been identified to cause cancer; yet, two types (HPV 16 and 18) account for 70% of all cervical cancer cases (Blake et al., 2015). These high-risk HPV infections may persist and increase the risk of developing cervical cancer, attributing to a rate of more than 12,000 new cases annually, with 4,000 deaths per year (Blake et al., 2015; Castellsague et al., 2009). If found early, screening Journal of Health Disparities Research and Practice Volume 12, Issue 3, Fall 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 96 Does Age Affect the Association between Race/Ethnicity and HPV Screening Marlin and Brunner Huber can prevent most cervical cancers through a preferred method called “co-testing,” a procedure that combines a Papanicolaou (Pap) test and HPV DNA test to detect early cervical cancers or precancers (American Cancer Society, 2016). It is recommended all women begin cervical cancer testing at age 21; however, a HPV test is not recommended for women aged 21-29 as the results are not regarded as significant as in women aged from 30-65 (American Cancer Society, 2018). Thus, in 2018, three updated options were recommended as screening guidelines for women aged 30-65: (a) high-risk HPV testing alone every 5 years, (b) co-testing every 5 years, or (c) Pap testing alone every 3 years (American Cancer Society, 2018; National Cancer Institute, 2019). In 2014, Hispanic women had the highest rate of developing cervical cancer, followed by non-Hispanic Black and non-Hispanic White women (Centers for Disease Control and Prevention, 2017d). Similarly, non-Hispanic Black and Hispanic women were more likely to die from cervical cancer than non-Hispanic White women (Blake et al., 2015). Subsequently, in 2016, cervical cancer incidence and mortality rates in non-Hispanic Black women were 38% and 105% higher, and in Hispanic women 70% and 52% higher compared to non-Hispanic White women, respectively (Bond et al., 2016). Thus, the relationship between race, ethnicity, and HPV screening becomes salient among minority populations, given cervical cancer incidence and mortality rates are considerably lower among non-Hispanic White women. Published guidelines from the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP), the American Society for Clinical Pathology and Screening (ASCPSG), and the American Congress of Obstetricians and Gynecologists (ACOG) recommend routine HPV screening be discontinued for average-risk women aged >65 years after three consecutive negative cytology results or two consecutive negative co-test results within the previous 10 years (CDC, 2017e; Elit, 2014; White et al., 2017). However, in 2014, of all new cervical cancers, 20% occurred in women 65 years old and older, and these women accounted for 34% of the deaths related to cervical cancer (Elit, 2014). Although, the frequency of new HPV infections decline with age, women aged 25-55 remain at risk of obtaining an oncogenic HPV strain (Poppe et al., 2010). Therefore, age itself may need to be reconsidered, given high cervical cancer incidence rates, increases in life expectancy, and different human papillomavirus exposures by birth cohort (White et al., 2017). Research on the association between race/ethnicity, HPV screening, and age among United States women aged 18-64 is sparse. Many studies have demonstrated disparities in awareness of and knowledge about HPV among young, immigrant, and minority populations (Ford, 2011; Blake et al., 2015). Similarly, prior studies have investigated the perceptions, behaviors, and impact of ethnicity among adolescent and young women aged 15-25 regarding the HPV vaccination (Bond et al., 2016; Castellsague et al., 2009; Sadry et al., 2013). Yet, there is a lack of existing research that has investigated the role of race/ethnicity and HPV screening, and how it varies by age. Therefore, the purpose of this study is to assess the relationship between race/ethnicity and HPV screening, and to evaluate whether age modifies this association using population-based data from the Behavioral Risk Factor Surveillance System (BRFSS). METHODS Study Population and Design This secondary data analysis used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS). This study protocol did not require approv (...truncated)