Human Papillomavirus Vaccine Impact on Cervical Precancers in a Low-Vaccination Population

Jaimie Z. Shing, Marie R. Griffin, Rachel S. Chang, Alicia Beeghly-Fadiel, Staci L. Sudenga, James C. Slaughter, Manideepthi Pemmaraju, Edward F. Mitchel, Pamela C. Hull

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Demonstrating human papillomavirus vaccine impact is critical for informing guidelines to increase vaccination and decrease human papillomavirus‒related outcomes, particularly in states with suboptimal vaccination coverage, such as Tennessee. This study examines the trends in high-grade cervical lesion incidence among Tennessee Medicaid-enrolled women aged 18–39 years and the subset of women who were screened for cervical cancer. Methods: Using a validated claims-based model to identify incident cervical intraepithelial neoplasia Grades 2 or 3 or adenocarcinoma in situ events, annual age group‒specific incidence rates from Tennessee Medicaid billing data, 2008–2018, were calculated. Significant trends were determined by Joinpoint. Analyses were conducted in 2020. Results: From 2008 to 2018, high-grade cervical lesion incidence significantly declined in women aged 18–20 years (average annual percentage change= −31.9, 95% CI= −38.6, −24.6), 21–24 years (average annual percentage change= −12.9, 95% CI= −22.3, −2.4), and 25–29 years (average annual percentage change= −6.4, 95% CI= −8.1, −4.6). Among screened women, rates significantly declined for ages 18–20 years (average annual percentage change= −20.3, 95% CI= −25.3, −15.0), 21–24 years (average annual percentage change= −10.2, 95% CI= −12.6, −7.8), and 25–29 years (average annual percentage change= −2.6, 95% CI= −3.9, −1.2). Trends from 2008 to 2018 were stable for older age groups (30–34 and 35–39 years). Conclusions: Results show reductions in high-grade cervical lesion incidence among ages most likely to have benefited from the human papillomavirus vaccine. Declines among young, screened women suggest causes other than reduction in screening. Evidence of vaccine impact in populations with low-vaccination coverage, such as Tennessee, is promising.

Original languageEnglish
Pages (from-to)395-403
Number of pages9
JournalAmerican Journal of Preventive Medicine
Volume62
Issue number3
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
JZS reports grants from NIH (5TL1TR002244, R01CA20740). MRG reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). ABF reports pilot grants from NIH (U54CA163072, U54MD010722). SLS reports a grant from the National Cancer Institute (K07CA225404). MP reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). EFM reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). PCH reports a grant from NIH (R01CA20740). No other financial disclosures were reported.

Funding Information:
The authors are indebted to the Human Papillomavirus Vaccine Impact Monitoring Project and the Tennessee Division of TennCare of the Department of Finance and Administration, who provided data. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of NIH or the Centers for Disease Control and Prevention (CDC). JZS reports grants from NIH (5TL1TR002244, R01CA20740). MRG reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). ABF reports pilot grants from NIH (U54CA163072, U54MD010722). SLS reports a grant from the National Cancer Institute (K07CA225404). MP reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). EFM reports a grant from the Emerging Infections Cooperative Agreement from the CDC (5U01C10003). PCH reports a grant from NIH (R01CA20740). No other financial disclosures were reported. Jaimie Z. Shing: Conceptualization; Formal analysis; Methodology; Visualization; Writing - original draft. Marie R. Griffin: Funding acquisition; Project administration; Supervision; Validation; Writing - Review & Editing. Rachel S. Chang: Writing - Review & Editing. Alicia Beeghly-Fadiel: Writing - Review & Editing. Staci L. Sudenga: Writing - Review & Editing. James C. Slaughter: Validation. Manideepthi Pemmaraju: Project administration. Edward F. Mitchel: Data Curation. Pamela C. Hull: Funding acquisition; Supervision.

Publisher Copyright:
© 2021 American Journal of Preventive Medicine

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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