IMPORTANCE Oropharynx cancer (OPC) incidence has increased for several decades in the US. It is unclear when and how this trend will be affected by current HPV vaccination trends. OBJECTIVE To assess the association of HPV vaccination with future OPC incidence in the US. DESIGN, SETTING, AND PARTICIPANTS This population-based age-period-cohort analysis obtained OPC incidence data from the Surveillance, Epidemiology, and End Results program from 69 562 patients 34 to 83 years of age diagnosed with OPC. The HPV vaccination data were obtained from the National Immunization Survey-Teen (60 124 participants) and National Health Interview Survey (16 904 participants). Data were collected from January 1, 1992, to December 31, 2017. Age-period-cohort forecasting models projected expected 2018 to 2045 OPC incidence under a counterfactual scenario of no HPV vaccination and current levels of HPV vaccination, stratifying by sex. Data analyses were completed by December 2020. EXPOSURES Age- and sex-specific cumulative prevalence of HPV vaccination in 2016 to 2017 projected forward. MAIN OUTCOMES AND MEASURES Projected OPC incidence and number of OPC cases expected to be prevented by HPV vaccination. RESULTS Under current HPV vaccination rates, between 2018 and 2045, OPC incidence is projected to decrease in younger individuals (36-45 years of age: from 1.4 to 0.8 per 100 000 population; 46-55 years of age: from 8.7 to 7.2 per 100 000 population) but continue to increase among older individuals (70-83 years of age: from 16.8 to 29.0 per 100 000 population). The association of HPV vaccination with overall OPC incidence through 2045 will remain modest (no vaccination vs vaccination: 14.3 vs 13.8 per 100 000 population in 2045). By 2045 HPV vaccination is projected to reduce OPC incidence among individuals 36 to 45 years of age (men: 48.1%; women: 42.5%) and 46 to 55 years of age (men: 9.0%; women: 22.6%), but among those 56 years or older, rates are not meaningfully reduced. Between 2018 and 2045, a total of 6334 OPC cases will be prevented by HPV vaccination, of which 88.8% of such cases occur in younger age (≤55 years) groups. CONCLUSIONS AND RELEVANCE According to the projections of this population-based age-period-cohort study, current HPV vaccination rates will have a limited association with overall OPC incidence through 2045 because older individuals who have not yet been vaccinated remain at high risk for OPC. However, reductions in OPC incidence should occur among young and middle-aged adults, the group at lowest risk of diagnosis. These findings forecast a continued shift in the landscape of OPC to an older population.

中文翻译：

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预计 2020-2045 年美国人乳头瘤病毒疫苗接种与口咽癌发病率的关联。

重要性 口咽癌 (OPC) 的发病率在美国已经增加了几十年。目前尚不清楚这种趋势何时以及如何受到当前 HPV 疫苗接种趋势的影响。目的 评估 HPV 疫苗接种与美国未来 OPC 发病率的关系。设计、设置和参与者这项基于人群的年龄-时期队列分析从监测、流行病学和最终结果项目中获得了 69562 名 34 至 83 岁诊断为 OPC 的患者的 OPC 发病率数据。HPV 疫苗接种数据来自全国免疫调查 - 青少年（60 124 名参与者）和全国健康访谈调查（16 904 名参与者）。数据收集时间为 1992 年 1 月 1 日至 2017 年 12 月 31 日。在没有 HPV 疫苗接种和当前 HPV 疫苗接种水平的反事实情景下，按性别分层，年龄-周期队列预测模型预测了 2018 年至 2045 年的预期 OPC 发病率。数据分析已于 2020 年 12 月完成。暴露预测 2016 年至 2017 年 HPV 疫苗接种的年龄和性别特定累积流行率向前发展。主要结果和措施 预测的 OPC 发病率和预计通过 HPV 疫苗接种预防的 OPC 病例数。结果 根据目前的 HPV 疫苗接种率，从 2018 年到 2045 年，预计 OPC 发病率在年轻人中会下降（36-45 岁：从每 10 万人中的 1.4 到 0.8；46-55 岁：从每 10 万人中的 8.7 到 7.2 100 000 人），但在老年人中继续增加（70-83 岁：从每 100 000 人 16.8 人增加到 29.0 人）。到 2045 年，HPV 疫苗接种与总体 OPC 发病率的关联将保持适度（未接种疫苗与疫苗接种：2045 年每 10 万人中 14.3 对 13.8）。到 2045 年，HPV 疫苗接种预计将降低 36 至 45 岁（男性：48.1%；女性：42.5%）和 46 至 55 岁（男性：9.0%；女性：22.6%）个体的 OPC 发病率，但在那些 56 岁或以上的人，费率并没有显着降低。2018年至2045年间，HPV疫苗接种将预防6334例OPC病例，其中88.8%的病例发生在年龄较小（≤55岁）的人群中。结论和相关性 根据这项基于人群的年龄-时期-队列研究的预测，目前的 HPV 疫苗接种率与 2045 年的总体 OPC 发病率的相关性有限，因为尚未接种疫苗的老年人仍然处于 OPC 的高风险中。然而，应该在青年和中年人中降低 OPC 发病率，这是诊断风险最低的群体。这些发现预测 OPC 的格局将继续向老年人口转移。