Sociodemographic factors associated with high-risk human papillomavirus infection

Obstet Gynecol. 2007 Jul;110(1):87-95. doi: 10.1097/01.AOG.0000266984.23445.9c.


Objective: To determine the prevalence of high-risk (cancer-associated) human papillomavirus (HPV) infection in U.S. women, identify sociodemographic factors associated with infection, and explore the implications for prevention of HPV-related disease in the vaccination era.

Methods: Women aged 14-59 years (n=1,921) participating in the 2003-2004 National Health and Nutrition Examination Survey provided a vaginal swab which was evaluated for 37 HPV types. We determined which sociodemographic characteristics were associated with high-risk HPV, using logistic regression models.

Results: High-risk HPV infection was present in 15.6% (95% confidence interval [CI] 12.6-18.6%) of participants, corresponding to a population prevalence of 12,028,293 U.S. women. Women living below the poverty line, compared with those living three or more times above it, were more likely to be positive for high-risk HPV (23% versus 12%, P = .03). Among participants living below the poverty line, only Mexican-American ethnicity (odds ratio [OR] 0.4, 95% CI 0.2-0.9) and unmarried status (OR 3.3, 95% CI 1.2-8.9) were associated with HPV prevalence. In contrast, several factors were associated with HPV among participants living above the poverty line, including black race (OR 1.4, 95% CI 1.0-2.0), income (OR 0.92, 95% CI 0.84-0.99), unmarried status (OR 2.0, 95% CI 1.3-3.0), and age (OR for 22-25 year olds 2.4, 95% CI 1.4-4.0).

Conclusion: High-risk HPV infection is common in U.S. women, particularly in poor women. Cervical cancer prevention efforts in the vaccination era must ensure that all low-income women have access to preventive services including education, Pap test screening, and HPV vaccines. Otherwise, existing disparities in cervical cancer could worsen.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Alphapapillomavirus / isolation & purification*
  • Female
  • Health Services Accessibility
  • Humans
  • Middle Aged
  • Nutrition Surveys
  • Odds Ratio
  • Papillomavirus Infections / economics
  • Papillomavirus Infections / epidemiology*
  • Papillomavirus Infections / ethnology
  • Papillomavirus Vaccines / therapeutic use
  • Poverty*
  • Prevalence
  • Racial Groups*
  • Risk Factors
  • Socioeconomic Factors
  • United States / epidemiology


  • Papillomavirus Vaccines