Burden of HPV Related Anogenital Diseases in Young Women in Germany – An Analysis of German Statutory Health Insurance Claims Data From 2012–2017 [post]

2020 unpublished
Most women and men are infected with human papillomavirus (HPV) at least once in their lifetime. Infections with low-risk types can cause genital warts, whereas high-risk types can cause malignant tumors. The aim of this study was to determine the burden of anogenital diseases potentially related to HPV in young women based on German statutory health insurance claims data. Methods We conducted a retrospective claims data analysis using the "Institute for Applied Health Research Berlin" (InGef)
more » ... ch Berlin" (InGef) Research Database, containing claims data from approximately 4 million insured individuals. In the period from 2012-2017 all women born in1989-1992, who were continuously insured between the age of 23-25 years were identified. Using ICD-10-GM codes (verified diagnosis in the outpatient sector or primary or secondary diagnosis in the inpatient sector) the administrative prevalence (95% confidence interval) of genital warts ( A63.0), anogenital diseases grade I (K62.8, N87.0, N89.0, N90.0), grade II (N87.1, N89.1, N90.1) and grade III (D01.3, D06.-, D06.0, D07.1, D07.2, N87.2, N89.2, N90.2) was calculated (women with diagnosis divided by all women). (birth cohort 1991) and 14,862 (birth cohort 1992) women at the age of 23-25 were identified. A decrease of the administrative prevalence was observed in genital warts (1.30% (1.12-1.49) birth cohort 1989 vs. 0.94% (0.79-1.10) birth cohort 1992) and anogenital diseases grade III (1.09% (0.93-1.26) birth cohort 1989 vs. 0.71% (0.58-0.86) birth cohort 1992). In anogenital diseases grade III, this trend was especially observed for severe cervical dysplasia (N87.2) (0.91% (0.76-1.07) birth cohort 1989 vs. 0.60% (0.48-0.74) birth cohort 1992). In contrast, anogenital diseases grade I (1.41% (1.23-1.61) birth cohort 1989 vs. 1.31% (1.14-1.51) birth cohort 1992) and grade II (0.61% (0.49-0.75) birth cohort 1989 vs. 0.52% (0.42-0.65) birth cohort 1992) remained stable. Conclusions A decrease of the burden of anogenital disease potentially related to HPV was observed in the younger birth cohorts. This was observed especially for genital warts and anogenital diseases grade III. Further research to investigate this trend for the upcoming years in light of varying HPV vaccination coverage for newer birth cohorts is necessary. 4 Background Human papillomavirus (HPV) infection belongs to the most frequent sexually transmitted infections in men and women worldwide [1]. Nearly all sexually active individuals will acquire at least one HPV infection in their life [2]. Although the majority of HPV infections are cleared spontaneously within a couple of months, they may become persistent with a subsequently increased risk of developing genital warts and certain cancer types [3]. HPV types capable of infecting mucosal epithelia are subdivided into low-risk and high-risk types. The low-risk types can lead to anogenital warts (condylomata acuminata). Low-risk types HPV 6 and 11 are responsible for approximately 90% of all anogenital wart cases [4]. Worldwide, several million cases of anogenital warts occur each year in both sexes, with a peak incidence between 20 and 24 years of age for women and between 25 and 29 years among men [5]. In Germany, a crude incidence rate of anogenital warts for women aged 10 to 79 years old was reported with 181 per 100,000 person years in 2010 [6]. High-risk HPV types can cause malignant conditions such as cervical intraepithelial neoplasia and cervical cancer [7], additionally, precancerous lesions and cancers at other anogenital sites are known to be associated with high-risk HPV. In Germany, about 4,600 women are newly diagnosed with cervical cancer every year and approximately 1,500 women die from cervical cancer per year [8]. It is assumed that high-risk HPV infections cause almost all cervical cancers and precancers, approximately 90% of high-grade anal, vulvar and vaginal intraepithelial neoplasias, and approximately 30%, 70%, and 90% of vulvar, vaginal and anal cancers, respectively [9, 10]. There are at least 12 high-risk HPV types, of which HPV 16 and 18 are responsible for 45% of cervical high-grade intraepithelial neoplasia and 70% of cervical cancers. Approximately 70-90% of HPV associated precancers and cancers at non-cervical anogenital sites are induced by HPV 16 and 18 [9]. HPV vaccination can prevent certain HPV infections and HPV-related anogenital diseases. The European Medicines Agency (EMA) authorized the first HPV vaccines in 2006 (quadrivalent vaccine against HPV 6, 11, 16 and 18) and 2007 (bivalent HPV 16 and 18) [11]. The quadrivalent vaccine may protect against HPV types causing approximately 70% of cervical cancers and 90% of genital warts List Of Abbreviations AIN Anal intraepithelial neoplasia APR Administrative prevalence rate CIN Cervical intraepithelial neoplasia
doi:10.21203/rs.2.12734/v3 fatcat:nwwyabbqnvg7vibamqdmn5khe4