Table 4. Stratified and subgroup analyses: fully adjusted a hazard ratios for high-grade cervical dysplasia and cervical cancer in patients with systemic inflammatory disease (SlD) compared to those without SID.
| SID | IBD | Psoriasis | RA | SLE | Non-SID | ||
|---|---|---|---|---|---|---|---|
| Pap smears or HPV-DNA testing done at baseline | |||||||
| Yes | |||||||
| N Outcomes | 58,110 163 |
12,623 42 |
15,795 38 |
23,362 61 |
6,330 22 |
220,766 468 |
|
| HR (95% CI) | 1.27 (1.01-1.60) |
1.23 (0.85-1.77) |
1.03 (0.73-1.46) |
1.73 (1.18-2.59) |
1.60 (0.98-2.59) |
Ref | |
| No | |||||||
| N Outcomes | 75,223 96 |
12,553 17 |
18,870 20 |
35,617 41 |
8,183 18 |
312,566 350 |
|
| HR (95% CI) | 1.01 (0.75-1.35) |
0.82 (0.48-1.41) |
0.85 (0.53-1.35) |
1.21 (0.77-1.92) |
1.46 (0.86-2.50) |
Ref | |
|
| |||||||
| Prior abnormal Pap smears | |||||||
| Yes | |||||||
| N Outcomes | 5,339 81 |
1,267 19 |
1,456 21 |
1,929 32 |
687 9 |
17,589 220 |
|
| HR (95% CI) | 1.23 (0.88-1.70) |
0.90 (0.52-1.55) |
1.17 (0.73-1.86) |
2.19 (1.29-3.72) |
1.18 (0.56-2.51) |
Ref | |
| No | |||||||
| N Outcomes | 127,994 178 |
23,909 40 |
33,209 37 |
57,050 70 |
13,826 31 |
515,743 598 |
|
| HR (95% CI) | 1.13 (0.92-1.41) |
1.13 (0.78-1.63) |
0.87 (0.62-1.23) |
1.31 (0.92-1.87) |
1.71 (1.14-2.56) |
Ref | |
|
| |||||||
| At least 1 gynecologic visit or procedure during the follow-up time | |||||||
| Yes | |||||||
| N Outcomes | 70,753 259 |
14,969 59 |
19,072 58 |
28,929 102 |
7,783 40 |
267,823 817 |
|
| HR (95% CI) | 1.14 (0.95-1.36) |
1.03 (0.76-1.39) |
0.94 (0.71-1.24) |
1.53 (1.13-2.06) |
1.52 (1.06-2.18) |
Ref | |
|
| |||||||
| Use of systemic immunosuppressive drugs at baseline b | |||||||
| Yes | |||||||
| N Outcomes | 46,626 85 |
3,150 10 |
6,862 11 |
33,568 52 |
3,046 12 |
533,332 c 818 |
|
| HR (95% CI) | 1.31 (0.97-1.77) |
1.72 (0.66-4.45) |
1.04 (0.43-2.51) |
1.40 (0.65-3.03) |
1.52 (0.64-3.61) |
Ref | |
| No | |||||||
| N Outcomes | 86,707 174 |
22,026 49 |
27,803 47 |
25,411 50 |
11,467 28 |
533,332 c 818 |
|
| HR (95% CI) | 1.15 (0.95-1.39) |
1.02 (0.73-1.42) |
0.96 (0.71-1.30) |
1.73 (1.21-2.47) |
1.53 (1.00-2.35) |
Ref | |
|
| |||||||
| Use of systemic steroids at baseline | |||||||
| Yes | |||||||
| N Outcomes | 50,208 102 |
6,814 19 |
5,820 5 |
30,831 55 |
6,743 23 |
533,332 c 818 |
|
| HR (95% CI) | 1.33 (1.00-1.76) |
1.30 (0.79-2.13) |
0.62 (0.25-1.50) |
1.49 (1.00-2.21) |
1.69 (1.05-2.72) |
Ref | |
| No | |||||||
| N Outcomes | 83,125 157 |
18,362 40 |
28,845 53 |
28,148 47 |
7,770 17 |
533,332 c 818 |
|
| HR (95% CI) | 1.14 (0.93-1.41) |
1.04 (0.73-1.48) |
1.04 (0.78-1.39) |
1.59 (1.06-2.38) |
1.45 (0.87-2.42) |
Ref | |
SID: systemic inflammatory disease, IBD: inflammatory bowel disease, RA: rheumatoid arthritis, SLE: systemic lupus erythematosus, HPV: human papillomavirus, HR: hazard ratio, CI: confidence interval
Adjusted for age, comorbidity score, no. of prescription drugs, alcoholism, smoking, substance abuse, being sexually active, diagnosis of sexually transmitted disease, oral and non-oral contraceptive use, receipt of HPV vaccine, diabetes, chronic kidney disease, liver disease, use of systemic immunosuppressive drugs, systemic steroids, and non-steroidal anti-inflammatory drugs, health care utilization factors, and preventive medical services.
Systemic immunosuppressive drugs include azathioprine, cyclophosphamide, cyclosporine, hydroxyurea, leflunomide, methotrexate, 6- mercaptopurine, mycophenolate, pimecrolimus, tacrolimus, abatacept, adalimumab, alefacept, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab, and ustekinumab.
The entire non-SID cohort was used as a comparison.