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Original article The associations of tobacco use, sexually transmitted infections, HPV vaccination, and screening with the global incidence of cervical cancer: An ecological time series modelling study
Luyan Zheng1orcid , Yushi Lin1orcid , Jie Wu1orcid , Min Zheng1orcid
Epidemiol Health 2022;e2023005
DOI: https://doi.org/10.4178/epih.e2023005 [Accepted]
Published online: December 13, 2022
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1Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
2Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
3Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
4Zhejiang University First Affiliated Hospital State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
5State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
Corresponding author:  Jie Wu,
Email: minzheng@zju.edu.cn
Min Zheng,
Email: minzheng@zju.edu.cn
Received: 15 September 2022   • Revised: 9 December 2022   • Accepted: 13 December 2022

Objectives
We aimed to quantify the temporal associations between cervical cancer incidence and cervical cancer-related factors and to predict the number of new cervical cancer cases averted under counterfactual scenarios compared to status quo scenario.
Methods
In this study, we described temporal trends in cervical cancer and its factors globally from 1990 to 2019. We then used generalized linear mixed models to explore the impact of tobacco use, sexually transmitted infections (STIs), human papillomavirus (HPV) vaccination and cervical screening on cervical cancer incidence. Counterfactual analysis was performed to simulate the most effective scenario for the reduction of cervical cancer incidence.
Results
The worldwide incidence of cervical cancer showed a downward trend over the past three decades (estimated annual percentage change [EAPC] = -0.72%), whereas the incidence remained high (>30 cases per 100,000 persons) in Sub-Saharan Africa, Latin America and the Caribbean. Higher smoking and STIs prevalence were significantly associated with increased incidence rates of cervical cancer, whereas lower HPV vaccination and screening coverage were significantly associated with increased cervical cancer incidence. If the strategic goals for accelerating the elimination of cervical cancer and tobacco control program were achieved in 2019, the largest decrease in the number of new cervical cancer cases would be observed, leading to 54,169 fewer new cases of cervical cancer in 2019.
Conclusions
Our counterfactual analysis found that a comprehensive intervention program emphasizing scale-up cervical screening coverage (70%), HPV vaccination coverage (90%), as well as tobacco control (30% relative reduction) was the most effective program for reducing cervical cancer incidence.


Epidemiol Health : Epidemiology and Health