Urban and Rural Safety Net Health Care System Clinics: No Disparity in HPV4 Vaccine Completion Rates

Abstract

ObjectiveSafety net health care centers in the US serve vulnerable and underinsured females. The primary aim of this work was to determine if HPV4 dosing compliance differs between females who receive doses at rural vs. urban core safety net health care locations.MethodsFemales exclusively receiving health care in the Truman Medical Center (TMC) safety net system at the urban core and rural locations were identified by their HPV4 vaccine records. Dates and number of HPV4 doses as well as age, gravidity, parity and race/ethnicity were recorded from the electronic medical record (EMR). Appropriate HPV4 dosing intervals were referenced from the literature.Results1259 females, 10–26 years of age, received HPV4 vaccination at either the rural (23%) or urban core location (77%). At the rural location, 23% received three doses on time, equal to the 24% at the urban core. Females seen in the urban core were more likely to receive on-time doublet dosing than on-time triplet dosing (82% vs. 67%, p<0.001). Mistimed doses occurred equally often among females receiving only two doses, as well as those receiving three doses.ConclusionsCompliance with on-time HPV4 triplet dose completion was low at rural and urban core safety net health clinics, but did not differ by location.

Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access

“…Consistent with other recent research using samples from North Carolina [18] and safety net clinics [27], we found no metropolitan status differences in adolescent vaccination, on average. However, we extend the research in this area by finding important subgroups for which metropolitan status differences are significant and substantial.…”

“…However, there is a paucity of research identifying factors that influence metropolitan status differences in actual HPV vaccination [5]. Studies that have examined these differences have been limited by the use of small data sets restricted to specific samples of girls or one specific geographic area [18, 22, 27]. …”

“…Although non-metropolitan areas have historically been medically underserved in prevention services [34] those disparities have been largely tempered by the introduction of federally funded community health centers [1, 23]. This suggests metropolitan and non-metropolitan girls may have similar access to preventive health services, including the HPV vaccine [27]. In addition, most health insurance providers now cover the HPV vaccination, and most adolescents who are uninsured, underinsured, or Medicaid-eligible are covered by the federal Free Vaccines for Children Program (VFC) (CDC [7], suggesting that variation in children’s insurance coverage across metropolitan and non-metropolitan places should play less of a role in HPV vaccination than in other types of adolescent health service use.…”