QUANTITATIVE RESEARCH
Factors Associated With Human Papillomavirus Infection Among Women in the Northwest Territories Paul Brassard, MD, MSc,1,2 Ying Jiang, MSc,3 Alberto Severini, MD,4 Vanessa Goleski, BSc,4 Maria Santos, MHSc,5 Susan Chatwood, BScN, MSc,6,7 Candice Lys, MA,7 Gordon Johnson, MD,8 Tom Wong, MD, MPH,7,9 Andrew Kotaska, MD,10 Kami Kandola, MD, MPH,5 Howard Morrison, PhD,3 Yang Mao, PhD3
ABSTRACT Background: In some regions, Aboriginal women have higher rates of cervical cancer compared to other Canadian women. However, little data are available regarding the co-factors of HPV infection in the Aboriginal population of Canada. We examined factors associated with high-risk human papillomavirus (HR-HPV) infection in a population of women (both Aboriginal and non-Aboriginal) in the Northwest Territories (NWT). Methods: We used a cross-sectional design using a convenience sample of all women aged 14 years or older presenting for Papanicolaou (Pap) testing across all regions of the NWT from March 2009 to March 2010. Women answered a questionnaire on demographic characteristics, sexual behaviour, and gynaecological and obstetrical events. We used multiple regression analysis to explore factors associated with HR-HPV infection according to age and cultural background. HPV typing was done using the Luminex assay. Results: Of the total 1,279 participants, 178 had missing HPV results. We obtained data on 1,101 women and overall HR-HPV prevalence was 14.2%. Younger age, single marital status, Aboriginal background, current smoking, lifetime deliveries, use of hormonal contraceptives, and the numbers of sexual partners in the last year were associated with prevalent HR-HPV. Discussion: Our findings tend to indicate that Aboriginal women have different predictors of HR-HPV than non-Aboriginal women that may affect HPV progression to cervical cancer. These findings can help to better target public health practices for the women at higher risk of HPV infection and cervical cancer. Key words: Human papillomavirus; determinants; Aboriginal La traduction du résumé se trouve à la fin de l’article.
C
ervical cancer is the second leading cause of cancer-related deaths among women worldwide. Human papillomavirus (HPV) has been found to be the precursor for cervical cancer in 99% of the cases. Global HPV prevalence among women is estimated at 10%, with approximately 75% of the female population acquiring an HPV infection at least once in their lives. Furthermore, some population groups appear to be at higher risk for infection than others.1,2 In Canada, approximately 1,300 new cervical cancer cases are diagnosed each year and 380 deaths are due to the disease.1 In some regions, Aboriginal women have higher rates of cervical cancer compared to other Canadian women.3-6 Data from Manitoba show that in comparison with non-Aboriginal women, Aboriginal women had 1.8 and 3.6 times the age-standardized incidence rates of in situ and invasive cervical cancer, respectively.4 In addition to oncogenic highrisk HPV (HR-HPV), several co-factors are needed in cervical carcinogenesis and little data are available regarding the determinants of HPV infection in the Aboriginal population of Canada.7 Aboriginal groups make up approximately half of the population of the Northwest Territories (NWT).8 A recent study among women in the NWT found that HPV prevalence was approximately 50% higher among Aboriginal than non-Aboriginal women (28% versus 18.8%, respectively).9 We wished to examine co-factors associated with HR-HPV infection in a population of women (both Aboriginal and non-Aboriginal) in the Northwest Territories. The identification of various factors associated with high-risk HPV could
e282 REVUE CANADIENNE DE SANTÉ PUBLIQUE • VOL. 103, NO. 4
Can J Public Health 2012;103(4):e282-e287.
help in the planning of cervical cancer prevention and intervention programs in this region.10-12
METHODS This cross-sectional design consisted of a convenience sample of all women aged 14 years or older presenting for a Papanicolaou (Pap) test across all regions of the NWT from March 2009 to March 2010. Participants were asked by their local health care provider to complete a questionnaire and to give written consent to both the questionnaire and HPV testing. Refusals to participate were not tabulated. The questionnaire consisted of 20 short multiple-choice Author Affiliations 1. 2. 3.
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC Department of Medicine, McGill University, Montreal QC Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, ON 4. National Microbiology Laboratory, PHAC, Winnipeg, MB 5. Department of Health & Social Services, Yellowknife, NT 6. Institute for Circumpolar Health Research, Yellowknife, NT 7. University of Toronto, Toronto, ON 8. Dynacare Kasper Medical Laboratories, Edmonton, AB 9. Centre for Communicable Diseases and Infection Control, PHAC, Ottawa, ON 10. Department of Obstetrics and Gynaecology, Stanton Territorial Hospital, Yellowknife, NT Correspondence: Dr. Paul Brassard, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, R4-29, Montreal, QC H3A 1A1, Tel: 514-340-7563, Fax: 514-340-7564, E-mail:
[email protected] Acknowledgements: This study was financially supported by the Government of Canada International Polar Year Program and the Public Health Agency of Canada. P. Brassard was supported by a clinician scientist career award from the Fonds de la Recherche en Santé du Quebec (FRSQ). Conflict of Interest: None to declare.
© Canadian Public Health Association, 2012. All rights reserved.
PREDICTORS OF HPV INFECTION
Table 1.
Determinants of Prevalent HR-HPV Infection OR (95%)
Characteristics Demographic Age (years) (N=1064)
