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State 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, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
© 2023, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
The authors have no conflicts of interest to declare for this study.
FUNDING
This study was funded by the National Natural Science Foundation of China (71904170), Mega-Project of National Science and Technology for the 13th Five-Year Plan of China (2018ZX10721102- 003-006, 2018ZX10715013-003-003), Technological Innovation Leading Talents of “Ten Thousand Talents Plan” of Zhejiang Province (2020R52010), and the Fundamental Research Funds for the Central Universities (K20210205).
AUTHOR CONTRIBUTIONS
Conceptualization: Zheng M, Wu J. Data curation: Zheng L, Lin YL. Formal analysis: Zheng L. Funding acquisition: Zheng M, Wu J. Methodology: Zheng L, Wu J, Zheng M. Project administration: Zheng M. Visualization: Zheng L, Lin Y. Writing – original draft: Zheng L, Lin Y, Wu J, Zheng M. Writing – review & editing: Zheng M, Wu J , Zheng L, Lin Y.
Factors1 | Relative change (%) |
95% UI |
p-value | |
---|---|---|---|---|
LL | UL | |||
Cervical screening | -2.442 | -2.920 | -1.975 | <0.001 |
HPV vaccination | -0.278 | -0.403 | -0.161 | <0.001 |
Tobacco use | 6.484 | 4.725 | 8.388 | <0.001 |
STIs | 12.402 | 9.346 | 15.282 | <0.001 |
UI, uncertainty interval; LL, lower limit; UL, upper limit; HPV, human papillomavirus; STIs, sexually transmitted infections.
1 Cervical cancer incidence, HPV vaccination, tobacco use, and STI prevalence rates were log-transformed; Before log-transformation, tobacco use and the STI prevalence rates were normalized on a scale of 0-1.
Scenarios1 | Relative change in incidence (%) |
95% UI |
Change in the no. |
95% UI |
||
---|---|---|---|---|---|---|
LL | UL | LL | UL | |||
Natural history | 5.56 | 5.44 | 5.57 | 28,646 | 23,864 | 32,307 |
Improved cervical screening only | -5.10 | -5.19 | -5.05 | -26,266 | -29,249 | -22,764 |
Improved HPV vaccination only | -3.51 | -3.54 | -3.27 | -18,076 | -18,971 | -15,538 |
WHO cervical cancer target | -8.43 | -8.56 | -8.32 | -43,394 | -48,238 | -37,531 |
WHO tobacco target | -2.28 | -2.41 | -1.97 | -11,427 | -11,764 | -10,576 |
Ideal 1 | -10.52 | -10.64 | -10.28 | -54,169 | -59,561 | -46,652 |
Ideal 2 | -8.45 | -8.58 | -8.35 | -43,532 | -48,388 | -37,639 |
37,639UI, uncertainty interval; LL, lower limit; UL, upper limit; HPV, human papillomavirus; WHO, World Health Organization; TCP, Tobacco Control Program.
1 The 7 scenarios were as follows: (1) Natural history: we simulated no cervical screening or HPV vaccination programs in 2019; (2) Improved cervical screening only: we simulated that the strategic goal for cervical screening launched by the Cervical Cancer Screening Program of the WHO was achieved in 2019; (3) Improved HPV vaccination only: we simulated that the strategic goal for HPV vaccination rates launched by the Cervical Cancer Screening Program of the WHO was achieved in 2019; (4) WHO cervical cancer target: we simulated that the strategic goals for cervical screening and HPV vaccination launched by the Cervical Cancer Screening Program of the WHO were achieved in 2019; (5) WHO tobacco target: we simulated that the strategic goals launched by the TCP (2019-2025) of the WHO were achieved in 2019; (6) Ideal 1: we simulated that the strategic goals set by the Cervical Cancer Screening Program and TCP of WHO were achieved in 2019 at the same time; (7) Ideal 2: we simulated that both cervical screening coverage and HPV vaccination rates increased to 100%.
Factors |
Relative change (%) | 95% UI |
p-value | |
---|---|---|---|---|
LL | UL | |||
Cervical screening | -2.442 | -2.920 | -1.975 | <0.001 |
HPV vaccination | -0.278 | -0.403 | -0.161 | <0.001 |
Tobacco use | 6.484 | 4.725 | 8.388 | <0.001 |
STIs | 12.402 | 9.346 | 15.282 | <0.001 |
Scenarios |
Relative change in incidence (%) | 95% UI |
Change in the no. | 95% UI |
||
---|---|---|---|---|---|---|
LL | UL | LL | UL | |||
Natural history | 5.56 | 5.44 | 5.57 | 28,646 | 23,864 | 32,307 |
Improved cervical screening only | -5.10 | -5.19 | -5.05 | -26,266 | -29,249 | -22,764 |
Improved HPV vaccination only | -3.51 | -3.54 | -3.27 | -18,076 | -18,971 | -15,538 |
WHO cervical cancer target | -8.43 | -8.56 | -8.32 | -43,394 | -48,238 | -37,531 |
WHO tobacco target | -2.28 | -2.41 | -1.97 | -11,427 | -11,764 | -10,576 |
Ideal 1 | -10.52 | -10.64 | -10.28 | -54,169 | -59,561 | -46,652 |
Ideal 2 | -8.45 | -8.58 | -8.35 | -43,532 | -48,388 | -37,639 |
UI, uncertainty interval; LL, lower limit; UL, upper limit; HPV, human papillomavirus; STIs, sexually transmitted infections. Cervical cancer incidence, HPV vaccination, tobacco use, and STI prevalence rates were log-transformed; Before log-transformation, tobacco use and the STI prevalence rates were normalized on a scale of 0-1.
37,639UI, uncertainty interval; LL, lower limit; UL, upper limit; HPV, human papillomavirus; WHO, World Health Organization; TCP, Tobacco Control Program. The 7 scenarios were as follows: (1) Natural history: we simulated no cervical screening or HPV vaccination programs in 2019; (2) Improved cervical screening only: we simulated that the strategic goal for cervical screening launched by the Cervical Cancer Screening Program of the WHO was achieved in 2019; (3) Improved HPV vaccination only: we simulated that the strategic goal for HPV vaccination rates launched by the Cervical Cancer Screening Program of the WHO was achieved in 2019; (4) WHO cervical cancer target: we simulated that the strategic goals for cervical screening and HPV vaccination launched by the Cervical Cancer Screening Program of the WHO were achieved in 2019; (5) WHO tobacco target: we simulated that the strategic goals launched by the TCP (2019-2025) of the WHO were achieved in 2019; (6) Ideal 1: we simulated that the strategic goals set by the Cervical Cancer Screening Program and TCP of WHO were achieved in 2019 at the same time; (7) Ideal 2: we simulated that both cervical screening coverage and HPV vaccination rates increased to 100%.