TY - JOUR
T1 - Incidence of oncogenic HPV infection in women with and without mental illness
T2 - A population-based cohort study in Sweden
AU - Herweijer, Eva
AU - Hu, Kejia
AU - Wang, Jiangrong
AU - Lu, Donghao
AU - Sparén, Pär
AU - Adami, Hans Olov
AU - Valdimarsdóttir, Unnur
AU - Sundström, Karin
AU - Fang, Fang
N1 - Publisher Copyright: © 2024 Herweijer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2024/3
Y1 - 2024/3
N2 - Background AWUom: Pelneawsiethcomnfeirnmtathl ailtlnalelhsesaedxinpgelreievenlcsaeraernepinrcerseeantseeddcorrisrkecotlfyc:ervical cancer. The excess risk is partly due to low participation in cervical screening; however, it remains unknown whether it is also attributable to an increased risk of infection with human papillomavirus (HPV). We aimed to examine whether women with mental illness had an increased infection rate of HPV compared to women without mental illness. Methods and findings Using a cohort design, we analyzed all 337,116 women aged 30 to 64 and living in Stockholm, who had a negative test result of 14 high-risk HPV subtypes in HPV-based screening, during August 2014 to December 2019. We defined women as exposed to mental illness if they had a specialist diagnosis of mental disorder or had a filled prescription of psychotropic medication. We identified incident infection of any high-risk HPV during follow-up and fitted multivariable Cox models to estimate hazard ratios (HR) with 95% confidence intervals (CI) for HPV infection. A totalAoUf 3:,2P6le3awseonmoteetnhawteasrepetrePsLteOdSpstoysleit;invuemfoerrahlisgahr-ernisoktaHllPowVedduatrtihnegbfeoglilonnwi-nugpof(amseendteiannc:e:Pleasecheckandconfirmthattheeditto}2.21 years; range: 0 to 5.42 years). The absolute infection rate of HPV was higher among women with a specialist diagnosis of mental disorder (HR = 1.45; 95% CI [1.34, 1.57]; p < 0.001) or a filled prescription of psychotropic medication (HR = 1.67; 95% CI [1.55, 1.79]; p < 0.001), compared to women without such. The increment in absolute infection rate was noted for depression, anxiety, stress-related disorder, substance-related disorder, and ADHD, and for use of antidepressants, anxiolytics, sedatives, and hypnotics, and was consistent across age groups. The main limitations included selection of the female population in Stockholm as they must have at least 1 negative test result of HPV, and relatively short follow-up as HPVbased screening was only introduced in 2014 in Stockholm. Conclusions Mental illness is associated with an increased infection rate of high-risk HPV in women. Our findings motivate refined approaches to facilitate the WHO elimination agenda of cervical cancer among these marginalized women worldwide.
AB - Background AWUom: Pelneawsiethcomnfeirnmtathl ailtlnalelhsesaedxinpgelreievenlcsaeraernepinrcerseeantseeddcorrisrkecotlfyc:ervical cancer. The excess risk is partly due to low participation in cervical screening; however, it remains unknown whether it is also attributable to an increased risk of infection with human papillomavirus (HPV). We aimed to examine whether women with mental illness had an increased infection rate of HPV compared to women without mental illness. Methods and findings Using a cohort design, we analyzed all 337,116 women aged 30 to 64 and living in Stockholm, who had a negative test result of 14 high-risk HPV subtypes in HPV-based screening, during August 2014 to December 2019. We defined women as exposed to mental illness if they had a specialist diagnosis of mental disorder or had a filled prescription of psychotropic medication. We identified incident infection of any high-risk HPV during follow-up and fitted multivariable Cox models to estimate hazard ratios (HR) with 95% confidence intervals (CI) for HPV infection. A totalAoUf 3:,2P6le3awseonmoteetnhawteasrepetrePsLteOdSpstoysleit;invuemfoerrahlisgahr-ernisoktaHllPowVedduatrtihnegbfeoglilonnwi-nugpof(amseendteiannc:e:Pleasecheckandconfirmthattheeditto}2.21 years; range: 0 to 5.42 years). The absolute infection rate of HPV was higher among women with a specialist diagnosis of mental disorder (HR = 1.45; 95% CI [1.34, 1.57]; p < 0.001) or a filled prescription of psychotropic medication (HR = 1.67; 95% CI [1.55, 1.79]; p < 0.001), compared to women without such. The increment in absolute infection rate was noted for depression, anxiety, stress-related disorder, substance-related disorder, and ADHD, and for use of antidepressants, anxiolytics, sedatives, and hypnotics, and was consistent across age groups. The main limitations included selection of the female population in Stockholm as they must have at least 1 negative test result of HPV, and relatively short follow-up as HPVbased screening was only introduced in 2014 in Stockholm. Conclusions Mental illness is associated with an increased infection rate of high-risk HPV in women. Our findings motivate refined approaches to facilitate the WHO elimination agenda of cervical cancer among these marginalized women worldwide.
UR - https://www.scopus.com/pages/publications/85188916712
U2 - 10.1371/journal.pmed.1004372
DO - 10.1371/journal.pmed.1004372
M3 - Article
C2 - 38527071
SN - 1549-1277
VL - 21
SP - 1
EP - 16
JO - PLoS medicine
JF - PLoS medicine
IS - 3
M1 - e1004372
ER -
