ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1039

Risk Of High-Grade Cervical Dysplasia In Women With Systemic Inflammatory Diseases

Seoyoung C. Kim1, Robert J. Glynn2, Edward Giovannucci3, Sonia Hernandez-diaz4, Jun Liu5, Sarah Feldman2, Elizabeth W. Karlson6, Sebastian Schneeweiss7 and Daniel H. Solomon8,9, 1Div. of Pharmacoepidemiology and Pharmacoeconomics, Div. of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, 2Brigham and Women's Hospital, Boston, MA, 3Harvard School of Publich Health, Boston, MA, 4Harvard School of Public Health, Boston, MA, 5Division of Pharmaoepidemiology, Brigham and Women's Hospital, Boston, MA, 6Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 7Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA, 8Division of Pharmacoepidemiology, Harvard Medical School, Brigham and Women's Hospital, Division of Rheumatology, Division of Pharmacoepidemiology, Boston, MA, 9Division of Rheumatology, Brigham and Women's Hospital, Boston, MA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Epidemiology and Health Services II & III

Session Type: Abstract Submissions (ACR)

Background/Purpose: Human papillomaviruses (HPV) are causes of high-grade cervical dysplasia and cervical cancer. Persistent HPV infection, the major risk factor for cervical cancer, is associated with several factors including HPV genotypes, age, coexisting infection, and immune function. Several prior studies suggested that the risks of any cervical dysplasia and HPV infection were increased in immunocompromised patients including those with HIV, organ transplantation, and systemic inflammatory diseases (SID). The objective of this study was to assess the risk of high-grade cervical dysplasia, a surrogate endpoint for cervical cancer, in women with SID including inflammatory bowel diseases (IBD), rheumatoid arthritis (RA), psoriasis, and systemic lupus erythematosus (SLE).

 

Methods: Using U.S. commercial insurance claims data (2001-2012), we conducted a population-based cohort study to examine the incidence rates (IR) of high-grade cervical dysplasia in women with SID including inflammatory bowel disease (IBD), rheumatoid arthritis (RA), psoriasis, and systemic lupus erythematosus (SLE). To have comparable health care utilization with the SID cohort, we selected women with hypertension as the non-SID cohort, matched on age and index date with a 4:1 ratio. The index date was defined as the dispensing date of the first immunomodulating drug after ≥ 2 diagnoses of one of the SID and the first anti-hypertensive drug after ≥2 diagnoses of hypertension for non-SID women. High-grade cervical dysplasia was defined by a validated claims-based algorithm with a positive predictive value of ≥81%. Crude and multivariable Cox models estimated the hazard ratios (HR) of high-grade cervical dysplasia in SID versus non-SID women. Separate Cox models were used to calculate HRs for IBD, RA, psoriasis, and SLE subcohorts compared to the non-SID. Our full model was adjusted for age, smoking, prior abnormal cervical dysplasia or sexually transmitted diseases, comorbidities, medications, and health care utilization. 

 

Results: Over the mean follow-up of 2.1 years, the IR of high-grade cervical dysplasia per 100,000 person-years was 94.2 among women with SID (n=133,333) and 73.4 in non-SID women (n=533,332). The fully adjusted HRs were 1.12 (95% CI 0.92-1.35) for all SID combined compared to non-SID. For the SID subcohorts, the fully adjusted HR was significantly increased in women with RA (1.46, 95% CI 1.07-2.01) and SLE (1.49, 95% CI 1.01-2.19), but not among those with IBD (1.06, 95% CI 0.78-1.44) or psoriasis (0.96, 95% CI 0.73-1.26). (Table) In women with baseline immunosuppressive use and with prior abnormal Papanicolaou smears, our results were unchanged.

Conclusion: Our study showed that RA and SLE were associated with a 1.5-times increased risk of high-grade cervical dysplasia after adjusting for potential confounders, although the absolute risk was generally low. 

 

Table. Hazard ratios (95% confidence intervals) for high-grade cervical dysplasia

 

 

 

Adjustment

SID*

(n=133,333)

 

 

IBD

(n=25,176)

 

 

Psoriasis

(n=34,665)

 

 

RA

(n=58,979)

 

 

SLE

(n=14,513)

Non-SID*

(n=533,332)

N, outcome

259

59

58

102

40

818

Unadjusted

1.28

(1.11-1.47)

1.50

(1.16-1.96)

1.11

(0.85-1.45)

1.13

(0.92-1.38)

1.90

(1.38-2.61)

Referent

Partial  a

1.24

(1.07-1.44)

1.18

(0.90-1.55)

0.98

(0.77-1.31)

1.38

(1.12-1.71)

1.61

(1.17-2.23)

Referent

Full b

1.12

(0.92-1.35)

1.06

(0.78-1.44)

0.96

(0.73-1.26)

1.46

(1.07-2.01)

1.49

(1.01-2.19)

Referent

*age and index date-matched, a adjusted for age, comorbidity score, and no. of prescription drugs. b further adjusted for HPV risk factors, comorbidities, medications, health care utilization and preventive health care use.

The likelihood ratio test of the global null hypothesis showed no significant heterogeneity between the SID subcohorts (p=0.1).

 

Disclosure:

S. C. Kim,

Pfizer Inc,

2,

Pfizer and Asisa ,

9;

R. J. Glynn,

AstraZeneca,

2,

Novartis Pharmaceutical Corporation,

2;

E. Giovannucci,
None;

S. Hernandez-diaz,

Novartis Pharmaceutical Corporation,

5,

GlaxoSmithKline,

5;

J. Liu,
None;

S. Feldman,
None;

E. W. Karlson,
None;

S. Schneeweiss,

WHISCON, LLC,

5,

Boehringer Ingelheim,

2,

Novartis Pharmaceutical Corporation,

2,

Pfizer Inc,

2,

Booz and Company,

5;

D. H. Solomon,

Lilly, Amgen, CORRONA,

2,

Lilly, Novartis, BMS, Pfizer,

6,

Lilly, BMS, Novartis,

9.

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