Prevalence and risk factors of human papillomavirus infection and cervical cytological lesions among women in Shanxi, China: a cross-sectional study

Abstract

With the introduction of human papillomavirus (HPV) vaccination into China’s national immunization programme in November 2025, robust baseline evidence on HPV epidemiology is critical. Data on HPV prevalence, genotype-specific distribution, risk factors, and the association between HPV infection and cervical cytology will provide a reference for monitoring vaccine impact and optimizing future cervical cancer prevention strategies. We conducted a retrospective cross-sectional study of women undergoing routine health examinations with concurrent HPV DNA testing and cervical cytology between January 2021 to December 2024 in Shanxi, China. We estimated genotype-specific and grouped HPV prevalence, assessed single and multiple infections, and compared genotype distributions across cytological categories. Logistic regression was used to assess factors associated with high-risk (HR-) HPV infection and cytological abnormalities. Among 19,384 women (median age 42 years, interquartile range 36–51), HR-HPV prevalence was 10.9%. The most frequent HR-HPV genotypes were HPV52 (2.3%), HPV16 (1.7%), and HPV58 (1.7%). The prevalence of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 was 2.3% and 7.4%, respectively. HR-HPV prevalence was higher in women aged ≥ 56 years (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] 1.6–2.3 for women aged 56–65 years compared to those aged 20–35 years) and lower in married women (AOR = 0.5, 95% CI 0.4–0.7). Abnormal cytology was observed in 2.1% of participants. Among HPV-positive women, HPV16/18 prevalence increased from low-grade squamous intraepithelial lesion (LSIL) to atypical squamous cells cannot exclude HSIL (ASC-H)/high-grade squamous intraepithelial lesion (HSIL) (OR = 3.4, 95% CI 1.0–11.5), while HPV31/33/45/52/58 prevalence showed a moderate but non-significant increase (1.8, 95% CI 0.6–5.6). Non-16/18/31/33/45/52/58 HR-HPV genotypes decreased with severity (OR = 0.6, 95% CI 0.1–2.2). HR-HPV infection was common among women undergoing health examinations in Shanxi with HPV52, HPV16, and HPV58 being the predominant genotypes, and HR-HPV prevalence increased with age. HPV genotype distributions varied substantially across different grades of cytological abnormalities, with HPV16/18 accounting for a larger proportion of high-grade cervical abnormalities. These findings highlight the importance of genotype-specific risk assessment in supporting genotype-specific risk assessment in HPV vaccination and cervical cancer prevention strategies.