Predictors of Human Papillomavirus Vaccination in a Large Clinical Population of Males Aged 11 to 26 years in Maryland, 2012–2013

Abstract

Background Despite the recommendation for routine human papillomavirus (HPV) vaccination in males, coverage estimates remain low. We sought to identify predictors of receiving each HPV vaccine dose among a large clinical population of males. Methods We conducted a cross-sectional analysis of electronic medical records for 14,688 males aged 11–26 years attending 26 outpatient clinics (January 2012 –April 2013) in Maryland to identify predictors of each HPV vaccine dose using multivariate logistic regression models with generalized estimating equations. All analyses were stratified in accordance with vaccine age recommendations: 11–12 years, 13–21 years, and 22–26 years. Analyses of predictors of receipt of subsequent HPV doses were also stratified by number of clinic visits (≤3, >3). Results Approximately 15% of males initiated the HPV vaccine. Less than half of males eligible received the second and third dose, 49% and 47%, respectively. Non-Hispanic black males (vs. non-Hispanic white) aged 11–12 and 13–21 years and males with public insurance (vs. private) aged 13–21 years, had significantly greater odds of vaccine initiation, but significantly decreased odds of receiving subsequent doses, respectively. Attendance to >3 clinic visits attenuated the inverse association between public insurance and receipt of subsequent doses. Conclusion Overall, rates of HPV vaccine initiation and of subsequent doses were low. While non-Hispanic black and publically insured males were more likely to initiate the HPV vaccine, they were less likely to receive subsequent doses. Impact Tailoring different intervention strategies for increasing HPV vaccine initiation versus increasing rates of subsequent doses among males may be warranted.

Disparities and reverse disparities in HPV vaccination: A systematic review and meta-analysis

“…HPV vaccination may offer racial and ethnic minority groups even greater potential for cancer reduction given their higher incidence of some HPV cancers. However, some studies suggest racial and ethnic disparities in HPV vaccine uptake (Chao et al, 2010;Wei et al, 2013), even as other studies suggest differences favor minorities (Clarke et al,2016;Reiter et al, 2013) or show no difference (Brewer et al, 2011;Hirth et al, 2014). We sought to comprehensively characterize differences between racial and ethnic minorities and Whites in HPV vaccine initiation and follow-through.…”

Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review

“…We then found 13 factors that were categorized as sociodemographic factors and social structure factors, including age, sexual orientation, relationship or marital status, parental age, race or ethnicity, education level, employment status, nativity status, number of children in the household, parental education level, parental marital status, language proficiency of caregivers, and parental employment status. Approximately half of the studies (n=16) explored age as a factor related to the HPV vaccination initiation [ 17 , 18 , 30 , 34 , 36 , 38 , 40 , 43 , 46 - 49 , 51 , 54 , 55 , 57 ]. Among them, 9 studies showed significant associations between age and vaccination [ 17 , 30 , 36 , 38 , 40 , 46 , 47 , 51 , 55 ].…”

“…Approximately half of the studies (n=16) explored age as a factor related to the HPV vaccination initiation [ 17 , 18 , 30 , 34 , 36 , 38 , 40 , 43 , 46 - 49 , 51 , 54 , 55 , 57 ]. Among them, 9 studies showed significant associations between age and vaccination [ 17 , 30 , 36 , 38 , 40 , 46 , 47 , 51 , 55 ]. However, the 5 studies with teenagers reported more vaccinations at older ages [ 17 , 36 , 40 , 46 , 47 ], whereas the other 4 studies covering populations aged up to 26 years reported the opposite relationship [ 30 , 38 , 51 , 55 ].…”

“…Among them, 9 studies showed significant associations between age and vaccination [ 17 , 30 , 36 , 38 , 40 , 46 , 47 , 51 , 55 ]. However, the 5 studies with teenagers reported more vaccinations at older ages [ 17 , 36 , 40 , 46 , 47 ], whereas the other 4 studies covering populations aged up to 26 years reported the opposite relationship [ 30 , 38 , 51 , 55 ]. The most frequently mentioned factor was race or ethnicity (n=20) [ 17 , 18 , 30 , 34 , 36 , 38 - 41 , 43 - 46 , 48 , 49 , 52 - 55 , 57 ]; of the 20 studies, 13 showed significant relationships between race or ethnicity and vaccination [ 17 , 18 , 34 , 36 , 38 , 40 , 41 , 43 , 44 , 46 , 52 , 54 , 57 ].…”

“…However, the 5 studies with teenagers reported more vaccinations at older ages [ 17 , 36 , 40 , 46 , 47 ], whereas the other 4 studies covering populations aged up to 26 years reported the opposite relationship [ 30 , 38 , 51 , 55 ]. The most frequently mentioned factor was race or ethnicity (n=20) [ 17 , 18 , 30 , 34 , 36 , 38 - 41 , 43 - 46 , 48 , 49 , 52 - 55 , 57 ]; of the 20 studies, 13 showed significant relationships between race or ethnicity and vaccination [ 17 , 18 , 34 , 36 , 38 , 40 , 41 , 43 , 44 , 46 , 52 , 54 , 57 ]. However, some of the results are inconsistent, with 7 studies reporting that Hispanics were more vaccinated than non-Hispanics [ 17 , 18 , 36 , 43 , 44 , 46 , 54 ]; other studies reported conflicting results that African Americans [ 34 , 38 ] were more vaccinated or Caucasians [ 40 , 52 ] were less vaccinated than other ethnic groups.…”