ETHNIC, GENDER, AND MARITAL STATUS DISPARITIES OF THE BURDEN OF CANCER-ATTRIBUTABLE INFECTIONS IN THE US: NHANES (1999-2012)

Purpose: Ethnicity, gender, and marital status have varying associations with the burden of infection in the US. Addressing and acknowledging the distribution of burden across these categories is important for public health intervention. National population-based surveys of such infections provide estimates of population-specific prevalence, trend, and determinants to identify cancer attributable to infections to eliminate the cancer burden by strengthening the public health policies. 

Method: American Cancer Association identified 13 infectious agents (Epstein-Barr virus, Hepatitis A/B/C/D, HSV-1, HPV, Chlamydia, H. pylori, Simian Virus 40, HTLV-1, MCV and HIV) that are likely to be linked to various cancers. National Health and Nutrition Examination Surveys (NHANES) provides a representative sample of the US non-institutionalized civilian population and contains information on all infectious agents except SV-40, H. pylori, and MCV. Prevalence of cancer-attributable infections is obtained from NHANES 1999-2012 and analyzed using SAS v9.3 (SAS Institute Inc., Cary, NC, USA) by taking into account the sampling design.

Result: Among those tested, married individuals had the highest prevalence of Hepatitis D (71.6%), HSV-1 (57.9%), HPV (56.5%), Hepatitis C (53.2%), and Hepatitis B (32.8%). Never married individuals had the highest burden of Chlamydia, HIV, and EBV infection. As for differences among ethnicities tested, Whites had the highest prevalence for Hepatitis C (66.5%), HPV (61.7%), Hepatitis B (60.7%), HSV-1 (56.2%), and EBV (50.2%). Blacks had the highest prevalence of HIV and Chlamydia, while “Other race” (including multi-racial) had the greatest burden of Hepatitis D infection. Females had a higher prevalence of Hepatitis D, Chlamydia, Hepatitis B, and EBV, whereas males had a higher prevalence of HPV, Hepatitis C, HIV, and HSV-1.

Conclusion: Our results show that cancer-linked infectious agents are unevenly distributed across ethnicities, gender, and marital statuses.  Taking into account the disparities of the burden of cancer-linked infections is important for effectively implementing prevention programs and addressing those with the most need.