PO.PS01.12 · 人群科学
地区剥夺指数与阿巴拉契亚年轻女性免疫功能及宫颈筛查异常史的关联
Association of Area Deprivation Index with immune functioning and history of abnormal cervical screening among Appalachian young women
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摘要 Abstract
中文摘要
引言：高慢性应激可影响免疫反应；因此，我们旨在考察居住在高剥夺地区（高应激源标志）如何与阿巴拉契亚年轻女性的Epstein-Barr病毒（EBV）再激活（免疫功能的替代测量指标）以及宫颈涂片（Pap）检查异常相关联。
方法：基线数据来自145名年龄18-26岁、参加社区意识、资源与教育（CARE II）倡议项目3的女性，该项目聚焦于减少俄亥俄州阿巴拉契亚地区的宫颈癌。地区剥夺指数（ADI）根据美国人口普查街区组数据进行地理编码，基于最高剥夺四分位数识别高剥夺和低剥夺地区。EBV分为低/阴性或中/高水平，后者提示免疫功能不良。还询问了参与者是否曾有过异常Pap检查（是/否）。使用带稳健方差的广义估计方程模型，对二元结局（EBV再激活和异常Pap检查）拟合了改良Poisson回归。所有模型均针对年龄组、种族、教育、吸烟状况、婚姻状况和保险进行了校正。
结果：参与者的平均年龄为22.8岁，大多数受过一些大学教育（53.3%），且从未结婚（65.4%）。中/高EBV再激活女性的比例在居住于高剥夺地区者中显著更高（89.5% vs. 69.1%，P=0.01）。同样，居住在高剥夺地区与报告异常Pap检查史增加超过2倍相关（46.7% vs. 22.7%，P=0.01）。与居住在低剥夺地区者相比，居住在高剥夺地区者中/高EBV再激活的风险增加31%（RR: 1.31，95% CI: 1.11-1.54）。在多变量校正后该关联仍显著（aRR: 1.29，95% CI: 1.06-1.56）。此外，与居住在低剥夺地区者相比，居住在高剥夺地区者报告既往异常Pap检查的风险为2.08倍（RR: 2.08，95% CI: 1.22-3.53），且在校正后仍显著（aRR: 2.11，95% CI: 1.12-3.99）。
结论：我们的研究发现，居住在高剥夺地区与EBV再激活（免疫功能不良的替代测量指标）和异常Pap检查史风险增加相关。居住地所引起的应激可能对免疫反应产生重大影响，应进一步考察以更好地实施宫颈癌控制工作。
查看英文原文 English abstract
Introduction : High chronic stress can influence immune response; therefore, we aimed to examine how residing in areas of high deprivation (marker for high stressor) is associated with Epstein-Barr Virus (EBV) reactivation, a proxy measure of immune function, and abnormal Papillomavirus (Pap) smear tests among young women in Appalachia.
Methods : Baseline data were available for 145 women aged 18-26 who were enrolled in the Community Awareness, Resources, and Education (CARE II) initiative, Project 3, which focused on reducing cervical cancer in the Ohio Appalachian. Area Deprivation Index (ADI) was geocoded from U.S. Census Block Group data to identify high- and low-deprivation areas based on the highest deprivation quartile. EBV was grouped into low/negative or medium/high levels, with the latter suggesting poor immune functioning. Participants were also asked if they ever had an abnormal Pap test (yes/no). Generalized Estimating Equations models with robust variance were fitted using a modified Poisson regression for binary outcomes: EBV reactivation and abnormal Pap test. All models were adjusted for age group, race, education, smoking status, marital status, and insurance.
Results : Average age of participants was 22.8 years, most had some college education (53.3%), and were never married (65.4%). The proportion of women with medium/high EBV reactivation was significantly higher among those residing in areas of high deprivation (89.5% vs. 69.1%, P=0.01). Similarly, living in high deprivation areas was associated with an over 2-fold increase in reporting a history of abnormal Pap tests (46.7% vs. 22.7%, P=0.01). Those living in high-deprivation areas had a 31% increased risk of medium/high EBV reactivation compared with those in low-deprivation areas (RR: 1.31, 95% CI: 1.11-1.54). This association remained significant after multivariable adjustment (aRR: 1.29, 95% CI: 1.06-1.56). Additionally, those living in high deprivation areas had 2.08 times the risk of reporting a past abnormal Pap test compared to those living in low deprivation areas (RR: 2.08, 95% CI: 1.22-3.53), and this remained significant after adjustment (aRR: 2.11, 95% CI: 1.12-3.99).
Conclusions : Our study found that residing in areas of high deprivation was associated with an increased risk of EBV reactivation, a proxy measure of poor immune functioning, and history of abnormal Pap tests. Stress caused by where one lives may have a significant impact on immune response and should be further examined to better implement cervical cancer control efforts.
利益披露 Disclosure
C. M. Hery, None..
Y. Kweon, None..
M. I. Elsaid, None..
C. DeGraffinreid, None..
M. T. Ruffin, None..
E. D. Paskett, None.