爱沙尼亚宫颈癌细胞学分级与 HPV 型别感染的疫苗前流行率

Prevaccination Prevalence of Type-Specific Human Papillomavirus Infection by Grade of Cervical Cytology in Estonia.

机构信息

Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.

Institute of Computer Science, University of Tartu, Tartu, Estonia.

出版信息

JAMA Netw Open. 2023 Feb 1;6(2):e2254075. doi: 10.1001/jamanetworkopen.2022.54075.

DOI:10.1001/jamanetworkopen.2022.54075

PMID:36745455

Abstract

IMPORTANCE

Large-scale data on type-specific human papillomavirus (HPV) prevalence and disease burden worldwide are needed to guide cervical cancer prevention efforts. Promoting the research and application of health care big data has become a key factor in modern medical research.

OBJECTIVE

To examine the prevaccination prevalence of high-risk HPV (hrHPV) and type distribution by cervical cytology grade in Estonia.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used text mining and the linking of data from electronic health records and health care claims to examine type-specific hrHPV positivity in Estonia from 2012 to 2019. Participants were women aged at least 18 years. Statistical analysis was performed from September 2021 to August 2022.

MAIN OUTCOMES AND MEASURES

Type-specific hrHPV positivity rate by cervical cytological grade.

RESULTS

A total of 11 017 cases of cervical cytology complemented with data on hrHPV testing results between 2012 and 2019 from 66 451 women aged at least 18 years (mean [SD] age, 48.1 [21.0] years) were included. The most common hrHPV types were HPV16, 18, 31, 33, 51 and 52, which accounted for 73.8% of all hrHPV types detected. There was a marked decline in the positivity rate of hrHPV infection with increasing age, but the proportion did not vary significantly based on HPV type. Implementation of nonavalent prophylactic vaccination was estimated to reduce the number of women with high-grade cytology by 50.5% (95% CI, 47.4%-53.6%) and the number with low-grade cytology by 27.8% (95% CI, 26.3%-29.3%), giving an overall estimated reduction of 33.1% (95% CI, 31.7%-34.5%) in the number of women with precancerous cervical cytology findings.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, text mining and natural language processing techniques allowed the detection of precursors to cervical cancer based on data stored by the nationwide health system. These findings contribute to the literature on type-specific HPV distribution by cervical cytology grade and document that α-9 phylogenetic group HPV types 16, 31, 33, 52 and α-7 phylogenetic group HPV 18 are the most frequently detected in normal-to-high-grade precancerous lesions in Estonia.

摘要

重要性

全球范围内需要大规模的特定类型人乳头瘤病毒（HPV）流行率和疾病负担数据，以指导宫颈癌预防工作。促进医疗保健大数据的研究和应用已成为现代医学研究的关键因素。

目的

研究爱沙尼亚宫颈癌前病变中，基于宫颈细胞学分级的 HPV 高危型（hrHPV）的流行率和型别分布。

设计、地点和参与者：本横断面研究使用文本挖掘技术，结合电子健康记录和医疗保健索赔数据，对 2012 年至 2019 年期间爱沙尼亚的特定类型 hrHPV 阳性率进行分析。参与者为年龄至少 18 岁的女性。统计分析于 2021 年 9 月至 2022 年 8 月进行。

主要结局和测量指标

宫颈细胞学分级的特定类型 hrHPV 阳性率。

结果

共纳入了 66451 名年龄至少 18 岁的女性在 2012 年至 2019 年期间 11017 例宫颈细胞学检查伴 hrHPV 检测结果的数据（平均[SD]年龄为 48.1[21.0]岁）。最常见的 hrHPV 类型是 HPV16、18、31、33、51 和 52，占所有检测到的 hrHPV 类型的 73.8%。随着年龄的增长，hrHPV 感染的阳性率显著下降，但 HPV 类型之间的比例没有显著差异。九价预防性疫苗的实施预计将使高级别细胞学检查的女性数量减少 50.5%（95%CI，47.4%-53.6%），低级别细胞学检查的女性数量减少 27.8%（95%CI，26.3%-29.3%），从而使宫颈癌前细胞学检查结果异常的女性总数减少 33.1%（95%CI，31.7%-34.5%）。

结论和相关性

在这项横断面研究中，文本挖掘和自然语言处理技术允许基于全国卫生系统存储的数据检测宫颈癌前病变。这些发现为基于宫颈细胞学分级的特定类型 HPV 分布文献做出了贡献，并记录了α-9 进化枝 HPV 16、31、33、52 和α-7 进化枝 HPV 18 是爱沙尼亚正常至高级别癌前病变中最常检测到的 HPV 类型。