Prevalence and Risk Factors of Human Papillomavirus infection and Cervical Cytological lesions Among Women in Shanxi, China: A Cross-Sectional Study

Background. China incorporated the Human papillomavirus (HPV) vaccine into the national immunization programme in October 2025. Population-level data on HPV prevalence and genotype distribution are essential for guiding local prevention strategies and establishing a baseline to evaluate vaccine effectiveness as coverage expands. Methods. We conducted a retrospective cross-sectional study including women who underwent routine health examinations with both HPV DNA testing and cervical cytology diagnosis at our hospital from January 2021 to December 2024 in Shanxi, China. We estimated type-specific and grouped HPV prevalence, assessed patterns of single and multiple HPV infections, and compared genotype distribution across cytological categories. Logistic regression was used to identify factors associated with high-risk HPV (HR-HPV) infection and cytological abnormalities. Results. A total of 19,384 women aged ≥ 18 years were included (median age 42 years, IQR 36–51). HR-HPV prevalence was 10.7%, with HPV52 (2.3%), HPV16 (1.7%), and HPV58 (1.7%) as the most common HR-HPV genotypes. The prevalence of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 was 2.3% and 5.1%, respectively. Women aged > 65 years had higher odds of HR-HPV infection (adjusted odds ratio [AOR] = 2.1, 95% CI 1.5–2.8), while married women had lower odds compared with unmarried women (0.5, 95% CI 0.4–0.7). Two percent of women had abnormal cytology. Among HPV-positive women, HPV16/18 prevalence increased substantially from low-grade squamous intraepithelial lesion (LSIL) to atypical squamous cells cannot exclude HSIL (ASC-H)/high-grade squamous intraepithelial lesion (HSIL) (OR = 3.4, 95% CI 1.0–11.5), HPV31/33/45/52/58 prevalence showed only a mild and non-significant rise (1.8, 95% CI 0.6–5.6), whereas non-16/18/31/33/45/52/58 HR-HPV prevalence declined (0.6, 95% CI 0.1–2.2). Conclusions. HR-HPV prevalence in Shanxi was moderate, dominated by genotypes 52, 16, and 58, and increased with age. These findings provide essential local baseline data for evaluating China’s newly implemented national HPV vaccination programme and highlight the need to expand vaccination coverage and enhance age-appropriate, genotype-informed screening strategies—particularly for older women who are unlikely to benefit from vaccination alone.