Impact of human papillomavirus vaccination on racial/ethnic disparities in vaccine-type human papillomavirus prevalence among 14–26 year old females in the U.S.

Abstract

Background: Low human papillomavirus (HPV) vaccination rates early after introduction, particularly among low income and minority adolescents, may have resulted in disparities in vaccine-type HPV prevalence (types 6, 11, 16, 18). The purpose of this study was to examine racial/ ethnic variations in HPV prevalence, and evaluate how HPV vaccination has affected vaccine-type HPV prevalence across time. Methods: This study was a retrospective analysis of 6 cycles of the National Health and Nutrition Examination Survey (NHANES) data (2003–2014). Results on HPV status from vaginal samples of 14–26 year old females who responded about HPV vaccination were used to determine HPV prevalence. Prevaccine HPV prevalence was compared to post-licensure prevalence. Racial/ ethnic comparisons were made across time, and models were developed to examine the role of HPV vaccination in observed variations in vaccine-type HPV prevalence. Results: Among 4,080 females, 29.7% were black, 25.6% were Mexican American, 8.9% were Hispanic, and 35.8% were white. Compared to prevaccine years (2003–2006), vaccine-type HPV did not decrease until late post-licensure years (2011–2014; 14.2% vs. 5.2%, p<0.001). Most of the decrease occurred among white females between prevaccine and late post-licensure periods (15.2% vs. 4.1%, p<0.001). Although a decrease in prevalence was observed among black females during the same periods (16.9% vs. 9.8%, p<0.05), it was not as large as among white females. Prevalence decreased among Mexican Americans (8.2 vs. 4.0, p>0.05) during the same periods, but the difference was not significant. Interactions between race and time were significant (p<0.001), with uneven vaccination between black and white females contributing to the disparities observed. Conclusions: HPV vaccination was low in among black and Mexican American females, which contributed to disparities in HPV prevalence. Increasing vaccination among all adolescents, particularly 11–12 year olds, is important because most children this age will not have been exposed.

Prevalence of HPV infection among sexually active adolescents and young adults in Brazil: The POP-Brazil Study

“…Although there are differences in prevalence according to region, race/color, social class and educational level were generally not significantly associated with HPV detection. Similar results have been reported in previous research studies in American and British populations 37,38 . Studies showing an effect of race and social class on HPV prevalence are often not comparable due to differences in the included population [39][40][41] , which is generally limited to specific groups.…”

Multiple HPV Infections and Viral Load Association in Persistent Cervical Lesions in Mexican Women

“…Along with sociocultural factors, ethnicity has shown to be an influence on the prevalence of HPV. For example, a study conducted in the United States that included 4080 females of which 29.7% were African-Americans, 25.6% were Mexican-Americans, 8.9% were Hispanics, and 35.8% were White, considering pre-vaccine years (2003)(2004)(2005)(2006), vaccine-type HPV, and late postlicensure years (2011-2014), there was a significant decrease in prevalence in the first two groups but not in Mexican-Americans [34].…”

Assessment of the Inclusion of Racial/Ethnic Minority, Female, and Older Individuals in Vaccine Clinical Trials

“… 31 These findings, combined with studies that document lower vaccination rates and increased disease burdens in some of these populations, demonstrate the need to improve minority group enrollment in clinical trials. 34 , 35 , 36 …”