Nativity status and genital HPV infection among adults in the U.S.

Over 43 million immigrants live in the United States (U.S.). Foreign-born populations experience multiple disparities related to human papillomavirus (HPV), including higher cervical cancer mortality rates, yet little research has examined the prevalence of genital HPV infection among this population. We used data from 1,822 women and 1,622 men ages 20-59 in the U.S. who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Participants reported their nativity status (foreign- vs. U.S.-born) and provided bio-specimens for HPV testing. We assessed nativity differences in the prevalence of three HPV infection outcomes (any HPV type, high-risk HPV type, and vaccine-preventable HPV type) using weighted logistic regression. Overall, 40% of women and 46% of men tested positive for any type of HPV. Compared to women born in the U.S., foreign-born women had a lower prevalence of infection with any HPV type (32% vs. 42%, p < .01). Compared to men born in the U.S., foreign-born men had a lower prevalence of all HPV infection outcomes (any type: 39% vs. 48%; high-risk: 22% vs. 34%; vaccine-preventable: 12% vs. 16%; all p < .05). Multivariable models attenuated several of these differences, though foreign-born men had lower odds of infection with a high-risk HPV type (OR = 0.75; 95% CI: 0.60-0.93, p < .01) after adjusting for covariates. Although lower than among their U.S.-born counterparts, HPV infection is prevalent among foreign-born women and men in the U.S. Findings can help inform strategic communication campaigns and targeted HPV vaccination and cervical cancer screening efforts for immigrant populations.