Disparities in human papillomavirus (HPV) vaccine initiation and completion based on sexual orientation among women in the United States

Abstract Background Since human papillomavirus (HPV) vaccine introduction in the United States in 2006, cervical pre-cancer incidence has declined in young women, but pre-cancer trends have not been reported by race/ethnicity. We evaluated trends in cervical pre-cancers from 2008 to 2016 in non-Hispanic (NH) white, NH black, NH Asian, and Hispanic women identified through active population-based surveillance in the 5-site Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT). Methods We analyzed data on cervical intraepithelial neoplasia (CIN) grades 2–3 and adenocarcinoma in situ (CIN2+) cases aged 20–39 years. Annual CIN2+ rates per 100,000 women were calculated stratified by race/ethnicity in 5-year age groups, using multiple imputation to account for 10% missing race/ethnicity data. Rates were also calculated using estimated numbers screened for cervical cancer to control for known declines in screening. Trends, evaluated using JoinPoint software, are presented as average annual percentage changes (AAPC) with 95% confidence intervals (CI). Results A total of 18,222 CIN2+ cases (62% NH white, 16% NH black, 16% Hispanic, 6% Asian) were reported from 2008 to 2016. CIN2+ rates among 20–24 year-olds declined significantly in all groups: NH white, AAPC: −14.2 (95% CI: −16.3, −12.1); NH black, AAPC: −15.5 (−19.5, −11.4); Asian, AAPC: −14.8 (−20.5, −8.8); Hispanic, AAPC: −14.3 (−17.9, −10.5). In 25–29 year olds, a significant decline was observed for NH whites only (AAPC: −2.4, [−4.0, −0.8]). No declines were seen in 30–34 or 35–39 year olds. Among screened 20–24 year-olds, significant but smaller declines were observed (AAPC: −9.8 to −8.4); no declines were observed in screened 25–29 year olds or older groups. Conclusion In this evaluation of CIN2+ trends by race/ethnicity during the HPV vaccine era, the significant declines in 20–24 year olds across all groups, including among screened women, is consistent with equitable vaccine impact on CIN2+. Disclosures All Authors: No reported Disclosures.

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Abstract PR-10: Tracking a decade of trends in human papillomavirus (HPV) vaccine hesitancy in the United States

10.1158/1538-7755.disp21-pr-10 ◽

2022 ◽

Author(s):

Dina Abouelella ◽

Nosayaba Osazuwa-Peters ◽

Eric Adjei Boakye

Keyword(s):

United States ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

The United States ◽

Vaccine Hesitancy

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Systematic identification and replication of factors associated with human papillomavirus vaccine initiation among adolescents in the United States using an environment-wide association study approach

Sexually Transmitted Infections ◽

10.1136/sextrans-2021-054976 ◽

2021 ◽

pp. sextrans-2021-054976

Author(s):

Tahmina Nasserie ◽

Eran Bendavid

Keyword(s):

Logistic Regression ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Methodological Approach ◽

The United States ◽

Healthcare Seeking ◽

Factors Associated ◽

Vaccine Initiation ◽

Poverty Status ◽

The Usa

ObjectiveHuman papillomavirus (HPV) vaccination coverage is low among adolescents in the USA. Identification of factors associated with HPV vaccine initiation (receipt of ≥1 dose) is critical for improving uptake. Our objective was to systematically investigate all eligible factors available in a nationally representative sample of adolescents to identify drivers of HPV vaccine initiation using a novel methodological approach.MethodsWe performed multiple cross-sectional analyses using data from the adolescent component of the National Immunization Surveys (NIS)-Teen between 2014 and 2019. Study participants were parents or caregivers of adolescents aged 13–17 years. Exposure variables measured sociodemographic and geographical characteristics, health conditions and healthcare provision. We tested the association between each factor and HPV vaccine initiation using univariate logistic regression and multivariate logistic regression adjusted for mother’s age, mother’s education level, mother’s marital status, poverty status and adolescent’s sex. We validated findings for each type of analysis within surveys, between surveys (across years 2014–2019) and across several subgroups (age, sex, poverty status and race/ethnicity).ResultsSix factors were replicated in the multivariate analysis. Most replicated factors characterised the role of healthcare providers and healthcare-seeking behaviours. After adjustment, provider HPV recommendation remained the most strongly associated with HPV vaccine initiation (2019 NIS-Teen: OR 13.4, 95% CI 11.3 to 17.3, p<0.001). The variance explained by a full model including replicated factors was 0.39.ConclusionsThis is the first study to explore the association between all available factors in the NIS-Teen and HPV vaccine initiation in a systematic manner. Our study suggests that healthcare-seeking behaviours and interactions with the health system may be drivers of HPV vaccine initiation and warrant further study. Addressing these factors could improve the rate of HPV vaccine initiation among adolescents in the USA.

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