No Access to Routine Healthcare Biggest Barrier to HPV Vaccination

BALTIMORE — People with access to routine healthcare were more likely to have received human papillomavirus (HPV) vaccination compared with those who did not have this access, a retrospective analysis of National Health and Nutrition Examination Survey data suggested.

Among participants ages 12 to 26, those with health insurance and a routine healthcare provider had a significantly higher rate of HPV vaccination initiation compared with those without health insurance (P<0.001 for males and females), reported Capt. Christina Bell, MD, of the Womack Army Medical Center in Fort Bragg, North Carolina, during her poster presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

“This study demonstrated the most apparent barrier to HPV vaccination was not having a routine place to go for healthcare,” the researchers concluded.

The CDC recommends HPV vaccination starting at age 11 or 12, but vaccine uptake remains low in the U.S., at 61.7% in 2021. The Healthy People initiative had a total vaccination goal of 80%, which was not met in 2020, and has since been extended to 2030.

Studies have shown HPV and cervical cancer disproportionately affect lower-income and minority women, while HPV-associated squamous cell carcinomas of the head and neck are rising, particularly among men. Half of new HPV infections occur before age 24.

In the 10-year period analyzed here (2009-2018), HPV vaccination increased overall but eventually plateaued, particularly among women for whom rates have remained around 50% for years.

“We haven’t really improved much since 2015,” Bell explained.

The percentage of women who received at least one HPV vaccine dose rose from 30.5% in 2009-2010 to 55.1% in 2017-2018. For men, rates rose from 8.3% in 2011-2012 to 36.4% in 2017-2018.

Race/ethnicity was not associated with vaccination initiation rates among both men and women (P>0.05). There was an effect of race/ethnicity on healthcare coverage (P<0.001).

Compared with non-Hispanic white respondents, both Mexican American and Black respondents were less likely to complete their HPV vaccine series.

“We were surprised that race did not affect the overall initiation of the HPV vaccine, but it did affect the completion,” Bell told MedPage Today.

“The [HPV] vaccine can be expensive. It can be over $200 per vaccine, and we’re telling you to get three of them. If you don’t have insurance, how are you getting that?” she said.

While there are organizations and societies that will cover the cost of HPV vaccination, a lot of patients don’t know that’s an option, she noted, adding this is one area in which doctors can do targeted outreach and education.

For this analysis, Bell and colleagues used data from the National Health and Nutrition Examination Survey from 2009 to 2018 and included participants ages 12 to 26. In total, data from 8,120 participants were analyzed, representing over 52 million people. Of these, 4,642 were women and 3,478 were men.

Home-based interviews were conducted to gather demographic and socioeconomic information, such as age, sex, race/ethnicity, insurance coverage, access to healthcare, and family poverty-to-income ratio.

The researchers noted that schools may play a role in identifying those who do not have access to regular healthcare and providing resources to those who need them.