Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA

McElfish, Pearl A.; Narcisse, Marie‐Rachelle; Felix, Holly C.; Cascante, Diana C.; Nagarsheth, Nirav; Teeter, Benjamin S.; Faramawi, Mohammed F.

doi:10.1007/s40615-020-00886-5

Cited by 20 publications

(21 citation statements)

References 35 publications

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“…This is similar to other research comparing HPV vaccination uptake by sex. 14–18 , 55 , 56 However, we found no difference in the magnitude of the intervention effect on HPV vaccination uptake after adding an interaction term between study arm and patient sex to adjusted models. As previously reported, 12 , 13 patients seen in rural clinics had lower likelihoods of vaccination than those in urban clinics.…”

Section: Discussioncontrasting

confidence: 60%

Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Harry

Asche

Freitag

et al. 2022

Human Vaccines & Immunotherapeutics

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Introduction Human papillomavirus (HPV) vaccination rates are low in young adults. Clinical decision support (CDS) in primary care may increase HPV vaccination. We tested the treatment effect of algorithm-driven, web-based, and electronic health record-linked CDS with or without shared decision-making tools (SDMT) on HPV vaccination rates compared to usual care (UC). Methods In a clinic cluster-randomized control trial conducted in a healthcare system serving a largely rural population, we randomized 34 primary care clinic clusters (with three clinics sharing clinicians randomized together) to: CDS; CDS+SDMT; UC. The sample included young adults aged 18–26 due for HPV vaccination with a study index visit from 08/01/2018–03/15/2019 in a study clinic. Generalized linear mixed models tested differences in HPV vaccination status 12 months after index visits by study arm. Results Among 10,253 patients, 6,876 (65.2%) were due for HPV vaccination, and 5,054 met study eligibility criteria. In adjusted analyses, the HPV vaccination series was completed by 12 months in 2.3% (95% CI: 1.6%–3.2%) of CDS, 1.6% (95% CI: 1.1%–2.3%) of CDS+SDMT, and 2.2% (95% CI: 1.6%–3.0%) of UC patients, and at least one HPV vaccine was received by 12 months in 13.1% (95% CI: 10.6%–16.1%) of CDS, 9.2% (95% CI: 7.3%–11.6%) of CDS+SDMT, and 11.2% (95% CI: 9.1%–13.7%) of UC patients. Differences were not significant between arms. Females, those with prior HPV vaccinations, and those seen at urban clinics had significantly higher odds of HPV vaccination in adjusted models. Discussion CDS may require optimization for young adults to significantly impact HPV vaccination. Trial Registration clinicaltrials.gov NCT02986230, 12/6/2016.

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Section: Discussioncontrasting

confidence: 60%

Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Harry

Asche

Freitag

et al. 2022

Human Vaccines & Immunotherapeutics

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“…The included studies addressed human papillomavirus (HPV) (n = 25), 21 , 29–31 , 35 , 37 , 40 , 42 , 44 , 46–48 , 50 , 53 , 55 , 57 , 60 , 61 , 65–68 , 71 , 72 , 74 influenza (n = 14), 20 , 24–26 , 28 , 36 , 41 , 46 , 47 , 52 , 58 , 59 , 63 , 64 hepatitis B (n = 11), 22 , 27 , 34 , 39 , 42 , 43 , 46 , 49 , 51 , 56 , 75 COVID-19 (n = 9), 18 , 19 , 23 , 32 , 38 , 45 , 54 , 69 , 73 pneumococcal (n = 6), 26 , 41 , 46 , 47 , 58 , 59 tetanus, diphtheria, pertussis/tetanus diphtheria (Tdap/Td) (n = 6), 33 , 41 , 42 , 46 , 47 , 62 hepatitis A (n = 2), 42 ...…”

Section: Resultsmentioning

confidence: 99%

“… 43 , 63 The majority of studies included both men and women (n = 43), while 12 focused on women, 28 , 40 , 44 , 48 , 58 , 51 , 61 , 66–68 , 70 , 71 and 2 on men. 50 , 59 The study aims included description of vaccination rates (n = 33), 18–20 , 22 , 24–27 , 29 , 30 , 32–34 , 36 , 37 , 39 , 41–43 , 46 , 47 , 49 , 51 , 57–62 , 64 , 65 , 69 , 72 barriers to vaccination (n = 34), 18 , 19 , 21–23 , 28 , 30–33 , 35 , 38–41 , 44 , 50–53 , 55 , 60 , 61 , 63–70 , 73 , 75 and interventions to improve vaccination (n = 6). 35 , 36 , 45 , 48 , 56 , 71 The majority of studies were designed as cross-sectional (n = 41), 18–31 , 33 , 34 , 37–41 , 43 , 44 , 46 ,…”

Section: Resultsmentioning

confidence: 99%

“… 35 , 36 , 45 , 48 , 56 , 71 The majority of studies were designed as cross-sectional (n = 41), 18–31 , 33 , 34 , 37–41 , 43 , 44 , 46 , 47 , 49 , 51 , 52 , 55 , 57–61 , 64–67 , 69 , 72 , 75 followed by qualitative (n = 10), 32 , 35 , 50 , 53 , 63 , 68 , 70 , 71 , 73 , 76 cohort (n = 3), 32 , 42 , 62 program evaluation (n = 2), 36 , 45 and quasi-experimental (n = 1). 56 Meta-analysis was performed for four vaccines: HPV (n = 7), 29 , 37 , 46 , 57 , 60 , 61 , 64 influenza (n = 7), 20 , 25 , 26 , 48 , 58 , 59 , 64 hepatitis B (n = 4), 27 , 46 , 49 , 51 and pneumococcal (n = 4). 26 , 46 , 58 , 59…”

Section: Resultsmentioning

confidence: 99%

“…Commonly identified barriers to vaccination prior to the COVID-19 pandemic included knowledge gaps (regarding the vaccine and the disease it prevents), 22 , 31 , 41 , 45 , 56 , 67 , 68 , 75 poor access to medical care (due to lack of health insurance or infrequent visits to a physician), 23–32 – 34–40 – 42–65 – 75 and cultural barriers (including language discordance and religiosity) 29 , 31 , 47 , 62 ( Table 4 ).…”

Section: Barriers To Vaccination In the Rim Populationmentioning

confidence: 99%

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Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Daniels

Imdad

Buscemi-Kimmins

et al. 2022

Human Vaccines & Immunotherapeutics

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Refugees, immigrants, and migrants (RIM) in the United States (US) have been identified as an underimmunized population prior to the COVID-19 pandemic. Vaccine acceptance is critical to combat the public health threat incited by COVID-19 and other vaccine-preventable disease. To better understand escalating vaccine hesitancy among US RIM, a comprehensive evaluation of the problem and solutions is necessary. In this systematic review, we included 57 studies to describe vaccination rates, barriers, and interventions addressing vaccine hesitancy over the past decade. Meta-analysis was performed among 22 studies, concluding that RIM represent an underimmunized population compared to the general US population. Narrative synthesis and qualitative methods were used to identify critical barriers, including gaps in knowledge, poor access to medical care, and heightened distrust of the medical system. Our results demonstrate the need for effective, evidence-based interventions to increase vaccination rates among diverse RIM populations.

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Human Papillomavirus Vaccine Administration Trends Among Commercially Insured US Adults Aged 27-45 Years Before and After Advisory Committee on Immunization Practices Recommendation Change, 2007-2020

et al. 2022

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ImportanceIn 2019, the Advisory Committee on Immunization Practices (ACIP) recommended patient-clinician shared decision-making for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years. Less is known about the HPV vaccine administration trends in this age group before and after this recommendation update.ObjectiveTo examine the association between the ACIP recommendation update and the HPV vaccine administration among US adults aged 27 to 45 years.Design, Setting, and ParticipantsThis large commercial claim-based retrospective cohort study used the Optum Clinformatics database for validated claims from January 1, 2007, through December 31, 2020. A total of 22 600 520 US adults aged 27 to 45 years without previous HPV vaccination claims during the study and enrollment period were included.Main Outcomes and MeasuresThe first-appearing HPV vaccination claim per individual was defined as a new HPV vaccine administration. Interrupted time-series analyses were conducted to assess the association between the ACIP update and the quarterly vaccine administration rate change. The annual rate trends across race and ethnicity groups and the proportions of vaccination cases by sub–age groups and valent types were also estimated. Vaccine administration trends were assessed by race and ethnicity in this age group because HPV vaccination trends were found to differ by race and ethnicity in the initially eligible population.ResultsAmong 22 600 520 final study participants, the majority were men (50.9%) and non-Hispanic White (53.4%), and the mean (SD) age when first observed was 34.6 (5.8) years. In women, the ACIP update was associated with an immediate increase in vaccine administration rate (coefficient β2, 40.18 per 100 000 persons; P = .01) and an increased slope (coefficient β3, 9.62 per 100 000 persons per quarter; P = .03) over time postupdate. The ACIP update was only associated with an immediate increase in vaccine administration in men (coefficient β2, 27.54; P &lt; .001). The annual rate trends were similar across race and ethnicity groups. Age at vaccine administration shifted over time (eg, women aged 40-45 years comprised only 4.9% of vaccinations in 2017, then 19.0% in 2019, and 22.7% in 2020). The most administered HPV vaccines in 2020 were 9 valent (women, 97.0%; men, 97.7%).Conclusions and RelevanceIn this population-based cohort study, there were statistically significant increases in HPV vaccine administration in adults aged 27 to 45 years after the ACIP recommendation update. Patient-clinician shared decision-making may have been the main associated factor for this increase. Further research is warranted to explore the decision-making process in receiving HPV vaccination and to develop effective decision aids to maximize the cancer prevention benefit in this age group.

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Race, Nativity, and Sex Disparities in Human Papillomavirus Vaccination Among Young Adults in the USA

Cited by 20 publications

References 35 publications

Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Human Papillomavirus vaccination clinical decision support for young adults in an upper midwestern healthcare system: a clinic cluster-randomized control trial

Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis

Human Papillomavirus Vaccine Administration Trends Among Commercially Insured US Adults Aged 27-45 Years Before and After Advisory Committee on Immunization Practices Recommendation Change, 2007-2020

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