Cervical Cancer Screening Patterns Among Women Living with and without HIV in the US: An Analysis of the NIH All of Us Research Program

Presenter:

Ruoqiuyan Zhang

Advisor:

Dr. Farzana Kapadia

Instructor:

Dr. Nina S Parikh

INTRODUCTION

INTRODUCTION

SIGNIFICANCE & GAPS

1. The population will be more general and target the whole population in the US
2. Previous studies did not examine screening adherence and patterns by HIV status
1. Analysis of the differences between groups can better guide future research to improve the guideline implementation and provide potential modifications.

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RESEARCH QUESTION

• RQ:
• What factors influence the cervical cancer screening guidelines adherence for women eligible for screening in the US, and are there any differences in cervical cancer screening patterns between HIV seronegative women and HIV seropositive women living in the US?
• Hypothesis:
• There are significant differences in cervical cancer screening patterns between HIV seronegative women and HIV seropositive women living in the US

METHODS – Data Source, Study Design, Measures

Data source

• NIH All of US Research Program
• Contains one of the largest genetic and health records data from over 1 million participants
• Aims to promote health-related research and advancing disease prevention and treatment

Study design

• Parent study: A longitudinal cohort study
• Thesis project
• A cross-sectional study

Measures

• Sample (N = 7608, HIV+ = 1268, HIV- = 6340)
• First, identify those who are HIV-infected. Then match the HIV-positive group to the HIV-negative group based on age (continuous) Ratio: 1:5
• HIV status (Identified by SNOMED codes)
• Cervical cancer screening status
• Identified by relevant procedure codes
• Other Covariates
• Race/ethnicity, gender identity, educational level, annual household income, marital status, sexual orientation, type of health insurance, employment, cigarettes smoking

METHODS – Participants, Data Collection

Parent Study

• Participants
• Inclusion: >18 yrs old, living in the US
• Exclusion: prisoners
• Data collection
• Questionnaires, EHRs, clinical setting at the time of enrollment, self-reporting at home

Thesis Project

• Participants
• Biological sex women aged from 21 to 65 years old (according to screening guidelines recommendation)

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• Variables will be obtained from surveys, EHRs, and physical measurements, from the controlled tier of the parent study

METHODS – Measures, Statistical Analysis

• HIV status (created)
• Identify SNOMED (Systematized Nomenclature of Medicine) codes
• Sample
• First, identify those who are HIV-infected. Then match the HIV-positive group to the HIV-negative group based on age (continuous)
• Outcome – Cervical cancer screening status
• Identify relevant screening procedures using procedure codes
• 1 = Yes, Pap or HPV test performed, 0 = No

Relevant covariates

• Race/ethnicity, gender identity, educational level, annual household income, marital status, sexual orientation, type of health insurance, employment status, etc.

METHODS – Statistical Analysis

• Conducted on the All of Us Researcher Workbench using R software version 4.1
• Univariate analysis (Categorical: frequency, percentage. Continuous: mean, standard deviations)
• Bivariate analysis (Categorical: Chi-square test. Continuous: ANOVA on ranks)
• Multivariate analysis
• Conditional logistic regression for matched data (Odds ratios, 95% Confidence interval, p-value)

RESULTS

• Univariate analysis
• Almost half of participants reported to have less than 35k income
• Over 20% of women were unable to work
• Bivariate analysis
• Larger proportion of HIV positive women have screening records, compared with HIV negative women

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RESULTS

RESULTS

• Conditional logistic regression for Multivariable Analysis
• Statistically significant variables: HIV status, Race/Ethnicity, Employment status, Cigarettes smoking, type of health insurance

CONCLUSION

• HIV positive participants were more likely to receive cervical cancer screening compared with HIV negative participants
• Compared with results from previous studies, the proportion of HIV positive women getting screened in this sample was lower.
• Null hypothesis was rejected and suggested that there are significant differences in cervical cancer screening patterns between HIV seropositive and HIV seronegative women living in the US

CONCLUSION

ACKNOWLEDGMENT

• Farzana Kapadia, PhD, MPH, Department of Epidemiology, School of Global Public Health, New York University
• Jessica Y. Islam, PhD, MPH, Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute
• Nina S. Parikh, PhD, MPH, Department of Social and Behavioral Science, School of Global Public Health, New York University
• Rebecca Yu, MS Candidate, Department of Biostatistics, School of Global Public Health, New York University
• Danning Tian, MS, Department of Biostatistics, School of Global Public Health, New York University
• Brandi Moore, PhD student in Department of Epidemiology, School of Global Public Health, New York University

REFERENCES

1. Castellsagué X. Natural history and epidemiology of HPV infection and cervical cancer. Gynecologic Oncology. 2008;110(3, Supplement 2):S4-S7. doi:10.1016/j.ygyno.2008.07.045
2. Cohen PA, Jhingran A, Oaknin A, Denny L. Cervical cancer. The Lancet. 2019;393(10167):169-182. doi:10.1016/S0140-6736(18)32470-X
3. Rahatgaonkar VG, Deshpande AA, Oka GA. Screening for cervical cancer in HIV-infected women: A review of literature. Indian Journal of Cancer. 2021;58(3):317. doi:10.4103/ijc.IJC_888_19
4. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674. doi:10.1001/jama.2018.10897
5. Kaplan JE, Masur H, Holmes KK, USPHS, Infectious Disease Society of America. Guidelines for preventing opportunistic infections among HIV-infected persons--2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51(RR-8):1-52.
6. Oster AM, Sullivan PS, Blair JM. Prevalence of Cervical Cancer Screening of HIV-Infected Women in the United States. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2009;51(4):430-436. doi:10.1097/QAI.0b013e3181acb64a

Images:

1. https://www.healthywomen.org/your-health/prevention--screenings/cervical-cancer-screening-save-life
2. https://www.medicaldevice-network.com/comment/cervical-cancer/

QUESTIONS?

THANK YOU FOR YOUR TIME!