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Table 3 Relative effectiveness of HPV testing versus cytology by income classifications

From: Real-world effectiveness of primary screening with high-risk human papillomavirus testing in the cervical cancer screening programme in China: a nationwide, population-based study

  Lower-middle-income areas Upper-middle-income areas
Cytology Overall HPV testing aOR (95%CI) Cytology Overall HPV testing aOR (95%CI)
Screen positivity (%, 95%CI) 4879 (3.1) 23 764 (9.6) 3.40 (3.29–3.51) 8345 (4.9) 60 827 (10.4) 2.27 (2.21–2.32)
Per protocol colposcopy referral (%, 95%CI)a 4879 (3.1) 9050 (3.7) 1.21 (1.17–1.25) 8345 (4.9) 19 982 (3.4) 0.69 (0.67–0.71)
Overall colposcopy referral (%, 95%CI) 4206 (2.7) 9721 (3.9) 1.55 (1.50–1.61) 8106 (4.8) 23 346 (4.0) 0.83 (0.80–0.85)
Per protocol detection rate of CIN or cancer (per 1000, 95%CI)
 CIN2+ 406 (3.0) 993 (4.7) 1.53 (1.37–1.70) 816 (5.6) 2867 (5.7) 1.03 (0.96–1.11)
  CIN2 or 3 368 (2.7) 912 (4.3) 1.55 (1.38–1.73) 757 (5.2) 2611 (5.2) 1.01 (0.94–1.09)
  Invasive cervical cancer 38 (0.3) 81 (0.4) 1.32 (0.92–1.89) 59 (0.4) 256 (0.5) 1.32 (1.02–1.71)
Overall detection rate of CIN or cancer b (per 1000, 95%CI)
 CIN2+ 417 (3.1) 1039 (4.9) 1.56 (1.40–1.73) 885 (6.0) 3060 (6.1) 1.01 (0.95–1.09)
  CIN2 or 3 373 (2.8) 938 (4.4) 1.57 (1.41–1.76) 798 (5.5) 2760 (5.5) 1.01 (0.94–1.09)
  Invasive cervical cancer 44 (0.3) 101 (0.5) 1.44 (1.03–2.01) 87 (0.6) 300 (0.6) 1.08 (0.86–1.35)
Positive predictive value c (%, 95%CI)
 CIN2+ 406 (9.9) 1018 (12.4) 1.23 (1.10–1.38) 816 (11.4) 3012 (14.3) 1.31 (1.21–1.41)
  CIN2 or 3 368 (9.0) 936 (11.4) 1.25 (1.11–1.40) 757 (10.6) 2732 (13.0) 1.27 (1.17–1.38)
  Invasive cervical cancer 38 (0.9) 82 (1.0) 1.02 (0.71–1.46) 59 (0.8) 280 (1.3) 1.65 (1.27–2.14)
  1. Note: HPV human papillomavirus, aOR adjusted odds ratio, CI confidential interval, CIN cervical intraepithelial neoplasia, ICC invasive cervical cancer, CI confidential interval. aPer protocol colposcopy referral was defined as the women who were screened positive and referred to colposcopy according to the protocol. b Overall detection rates included cases detected in per protocol colposcopy and others detected in opportunistic colposcopy. c Positive predictive value represented the detected cases from screened positivity. aOR was calculated by using multivariate logistic regression adjusted for age and ever screening