Incidence of human papillomavirus infections in women aged 27 years and older in the US: A federated data network study

OBJECTIVES: The US Advisory Committee on Immunization Practices recommends shared clinical decision-making regarding human papillomavirus (HPV) vaccination for individuals aged 27-45 years. The incidence of HPV infection in this age group is not well-understood. This study assessed anogenital HPV infection incidence in a large cohort of unvaccinated US women aged ≥27 years. METHODS: This retrospective cohort study included women aged ≥27 years who had a documented visit, no prior record of HPV vaccination, and a confirmed negative HPV test within the TriNetX Dataworks-USA network (a large, de-identified, federated network of electronic health records [EHRs]) between January 1, 2012 and January 6, 2024. Cumulative incidence of HPV infection over 5 years was calculated, overall and stratified by age and demographic characteristics. Analyses were also conducted in a subset of the population whose EHRs were linked to closed health insurance claims data via tokenization (the Linked sample). RESULTS: The overall 5-year cumulative incidence rate in the Dataworks sample (n = 305,974) was 10.3% (95% confidence interval, 10.2-10.5%). Cumulative incidence estimates were highest in the younger age groups, declined until age 59, and then increased among women aged ≥70 years. Analyses in a subset of 9772 women in the Linked sample showed similar patterns. Higher HPV infection incidence was observed among Black, Hispanic, and Medicaid-enrolled women. CONCLUSION: In a large cohort of US women aged ≥27 years, new HPV infections were acquired throughout the lifespan. These women and their partners can benefit from preventive strategies to reduce risk of HPV-related diseases.