Can Healthy Diet Buffer the Impact of Adverse Social Determinants on HPV Infection? Evidence From NHANES 2005–2016

OBJECTIVES: Persistent high-risk HPV infection can trigger malignant tumors. The associations of social determinants of health (SDoH) and Healthy Eating Index-2020 (HEI-2020) with HPV remain unclear. HPV prevalence varies across socioeconomic levels, and while SDoH is hard to change in the short term, diet is modifiable. Given these differences, it remains to be clarified whether a high-quality diet is associated with lower HPV risk. METHODS: Using NHANES data (2005-2016), weighted logistic regression analyzed separate/combined links of SDoH and HEI-2020 with HPV infection, and subgroup effects were estimated. RESULTS: The study included 6172 eligible participants, among whom 2650 developed HPV infection, with a positive rate of 42.9%. Weighted logistic regression analysis identified a positive association between high-burden SDoH and HPV infection (OR = 1.294, 95% CI: 1.060-1.580) and a negative association between HEI-2020 and HPV infection (OR = 0.761, 95% CI: 0.603-0.961). As for the combined effect of SDoH and HEI-2020 on HPV infection, high-burden SDoH and poor dietary quality were significantly positively associated with HPV infection (OR = 1.511, 95% CI: 1.170-1.952). HEI modulated the effect of SDoH. Subgroup analysis indicated that the association between the combined effect of SDoH and HEI-2020 and HPV infection was stable across all subgroups. CONCLUSION: For vulnerable populations at high risk, it is essential to adopt a comprehensive public health strategy. This strategy must be based on three core measures: HPV vaccination, cervical cancer screening, and improved access to healthcare services. Within this comprehensive support framework, systematically incorporating evidence-based nutritional guidance can promote overall health and help reduce health inequities.