患有和未患有精神疾病的女性中致癌型 HPV 感染的发生率:瑞典一项基于人群的队列研究。

IF 15.8 1区 医学 Q1 Medicine PLoS Medicine Pub Date : 2024-03-25 eCollection Date: 2024-03-01 DOI:10.1371/journal.pmed.1004372
Eva Herweijer, Kejia Hu, Jiangrong Wang, Donghao Lu, Pär Sparén, Hans-Olov Adami, Unnur Valdimarsdóttir, Karin Sundström, Fang Fang
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引用次数: 0

摘要

背景:患有精神疾病的女性罹患宫颈癌的风险会增加。宫颈癌风险增加的部分原因是宫颈癌筛查参与率低,但是否与感染人类乳头瘤病毒(HPV)的风险增加有关,目前仍不得而知。我们旨在研究与没有精神疾病的女性相比,患有精神疾病的女性感染人乳头瘤病毒的比例是否会增加:我们采用队列设计,分析了所有 337116 名年龄在 30 至 64 岁、居住在斯德哥尔摩的女性,她们在 2014 年 8 月至 2019 年 12 月期间进行的基于 HPV 的筛查中,14 种高风险 HPV 亚型的检测结果均为阴性。如果妇女经专科医生诊断患有精神障碍或开具了精神药物处方,我们就将其定义为暴露于精神疾病。我们确定了随访期间感染任何高危 HPV 的事件,并通过多变量 Cox 模型估算出 HPV 感染的危险比 (HR) 及 95% 置信区间 (CI)。在随访期间(中位数:2.21 年;范围:0 至 5.42 年),共有 3263 名妇女的高危 HPV 检测结果呈阳性。与无精神障碍的妇女相比,有精神障碍专科诊断(HR = 1.45;95% CI [1.34,1.57];p < 0.001)或精神药物处方(HR = 1.67;95% CI [1.55,1.79];p < 0.001)的妇女的 HPV 绝对感染率更高。抑郁症、焦虑症、压力相关障碍、药物相关障碍和多动症,以及使用抗抑郁药、抗焦虑药、镇静剂和催眠药的绝对感染率均有所上升,且各年龄组的情况一致。研究的主要局限性包括对斯德哥尔摩女性人群的选择,因为她们必须至少有一次人乳头瘤病毒阴性检测结果;以及随访时间相对较短,因为斯德哥尔摩在2014年才引入基于人乳头瘤病毒的筛查:结论:精神疾病与女性高危 HPV 感染率的增加有关。我们的研究结果促使我们改进方法,以促进世界卫生组织在全球这些边缘化妇女中消除宫颈癌的议程。
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Incidence of oncogenic HPV infection in women with and without mental illness: A population-based cohort study in Sweden.

Background: Women with mental illness experience an increased risk of cervical 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 total of 3,263 women were tested positive for high-risk HPV during follow-up (median: 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 HPV-based 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.

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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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