Open Access Highly Accessed Research article

A prospective study of age trends of high-risk human papillomavirus infection in rural China

Le-Ni Kang1, Philip E Castle2, Fang-Hui Zhao1, Jose Jeronimo3, Feng Chen1, Pooja Bansil3, Jing Li1, Wen Chen1, Xun Zhang1 and You-Lin Qiao1*

Author Affiliations

1 Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Lane, Beijing, 100021, China

2 Global Cancer Initiative, 100 Radcliff Drive, Chestertown, MD, 21620, USA

3 PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA

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BMC Infectious Diseases 2014, 14:96  doi:10.1186/1471-2334-14-96

Published: 21 February 2014



In China, high-risk human papillomavirus (HR-HPV) prevalence is unexpectedly high in older women, but the possible reasons have not been well studied yet. This study investigated the age trends of HR-HPV infection in a prospective study.


A total of 7397 women aged 25-65 years without cervical precancer or cancer were evaluated during 2010-2011 with a stratified sample of 2791 women re-evaluated after one year. Test results for careHPV and careHPV16/18/45 were used to describe the HR-HPV prevalence, incidence and clearance. Risk factors associated with HR-HPV infections were explored using a logistic regression model.


The overall HR-HPV prevalence was 13.1% at baseline, with a peak of 19.3% in women aged 55-59 years. The prevalence of HR-HPV (p for trends < 0.001), HPV16/18/45 (p for trends = 0.002), and HR-HPV other than HPV16/18/45 (p for trends = 0.002) generally increased with increasing age. Number of infections that cleared was generally greater than number of incident infections within age groups. One-year clearance rate decreased with increasing age (p for trends < 0.001), however, incidence rate was unrelated to age (p for trends = 0.159). Risk factors that associated with HR-HPV infection differed between younger and older women.


The greater HR-HPV prevalence in older versus younger women in rural China may be explained by a cohort effect, higher than expected incidence, and/or poorer clearance at older age.

Human papillomavirus; Infection; Age; Risk factor; Cohort effect