Visualizing Immunization Registry Data to Identify Places With Low Rates of HPV Vaccination Initiation in a Rural State

Abstract

Covariate-adjusted initiation rates for human papillomavirus vaccination in zip code tabulation areas (ZCTAs) among adolescents aged 13 to 15, Iowa, 2016. Rates were spatially smoothed to account for small populations. The state-level mean vaccination rate for all ZCTAs was 47.9% (range, 0%-100%; standard deviation, 16.2%). All ZCTAs have initiation rates below the Healthy People 2020 target of 80% completion. Urban ZCTAs are indicated in black outlines. Vaccination initiation rates exhibit no clear association with location.

Identifying Area-Level Disparities in Human Papillomavirus Vaccination Coverage Using Geospatial Analysis

“…Given the positive association between population density and vaccination coverage, there may be a need to focus on increasing HPV vaccination among rural populations. Although other studies have highlighted lower uptake in rural areas (15), this study shows the quantitative relationship between population density and vaccination completion, which has not been previously reported. The inverse association between average number of vehicles per household and vaccination coverage could reflect what we see with the population density effect, as households in urban areas likely have lower vehicle ownership.…”

“…In addition, McKillop and colleagues (14) found that adolescent females A strength of this study is the Bayesian spatial modeling approach allowing for estimation of the probabilities of vaccination of girls and boys independently as well as simultaneously in a model that permits them to be correlated. This is an innovation in the HPV vaccination literature, where separate models have been used for boys and girls (13), or boys and girls have been combined into one outcome variable (15). In addition, we identified the geographic areas of significantly lowered vaccination coverage, which has not been done in other geospatial analyses of HPV vaccination (13,15,32).…”

“…This is an innovation in the HPV vaccination literature, where separate models have been used for boys and girls (13), or boys and girls have been combined into one outcome variable (15). In addition, we identified the geographic areas of significantly lowered vaccination coverage, which has not been done in other geospatial analyses of HPV vaccination (13,15,32).…”

“…The results demonstrated significant clustering of vaccination rates for boys, lower rates in areas of higher poverty, and lower rates where there was a shortage of healthcare providers. Although this study (13) and others (14,15) that use immunization registry data afford some insights into geospatial correlations of HPV vaccine coverage, they did not consider correlation in vaccination between boys and girls that could be driven by shared risk factors or intervention efforts.…”

“…Despite being one of the few states to mandate vaccination of females for school entry, the overall rate of HPV vaccine coverage within Virginia remains low. Given the findings of variation in vaccination in other states, including North Carolina, Texas, and Iowa (13)(14)(15), the aims of this article were to (i) model the variation in vaccination rates among boys and girls within Virginia, (ii) determine whether neighborhood socioeconomic variables explain variation in HPV vaccination, and (iii) identify areas with significantly depressed vaccination coverage. To accomplish these aims, we used a novel analytic approach (Bayesian hierarchical spatial models) to model the correlation in vaccination among boys and girls, as well as the spatial correlation in vaccination for each sex.…”