Association of Area Deprivation Index with immune functioning and history of abnormal cervical screening among Appalachian young women

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.