Analysis of Dose-Specific Human Papillomavirus (HPV) Vaccination by Insurance Type Using the National Immunization Survey-Teen, 2015 Público

Abstract

Objectives. Prior research on insurance coverage and human papillomavirus (HPV) vaccination has focused on overall insurance overage and evaluating the outcomes of initiation and completion. To address gaps in understanding of partial vaccination, we conducted a comprehensive analysis of dose- and insurance type-specific vaccine coverage among teens on private insurance, Medicaid, and military insurance to understand differences in HPV vaccine series initiation, non-series-completion, and series completion.

 

Methods. We analyzed the association between insurance type and HPV vaccination using 2015 National Immunization Survey-Teen (NIS-Teen) data. The main outcome variable was HPV vaccination, compared in two ways: initiation of HPV vaccine series to non-initiation of HPV vaccine series, and comparison of receipt of 1, 2, or 3 doses of HPV vaccine to those who did not initiate. The primary exposure variable was type of insurance coverage, defined as private, Medicaid, or military/other; with comparisons made to all adolescents without a given type of insurance. A secondary exposure compared insurance types (Medicaid, military, Medicaid and military, and none of the above) to private insurance.

 

Results. Male and female adolescents utilizing Medicaid were more likely to initiate vaccination compared to other male and female adolescents (adjusted Prevalence Ratio 1.16, 95% CI 1.07-1.25 for male; PR 1.19, 95% CI 1.08, 1.31 for females). Similarly, both male and female adolescents had a higher likelihood of vaccination at each dose level. Adolescents utilizing both Medicaid and military insurance were more likely to have received multiple doses without completing the HPV vaccine series compared to those with private insurance (PR for 2 doses compared to 0 doses 1.57, 95% CI 0.98-2.53).

Conclusions. HPV vaccine uptake remains suboptimal in the US. We have documented differences in dose-specific HPV vaccine uptake by insurance type that maintain consistent patterns by sex. With lower vaccine uptake among adolescents with private insurance, these findings highlight the importance of assessing both financial and non-financial barriers to HPV vaccination. Continued monitoring of HPV vaccine uptake patterns, particularly for younger adolescents who only need two vaccine doses, is important to tracking barriers to optimal vaccine coverage.

Table of Contents

Table of Contents

1. Introduction ................................................................................................................. 1

2. Methods ........................................................................................................................ 1

3. Results .......................................................................................................................... 3

3.1 Prevalence of HPV vaccination in females .................................................... 3

3.2 Prevalence of any dose of HPV vaccination in females ................................. 4

3.3 Dose-specific prevalence of HPV vaccination in females............................... 4

3.4 Prevalence of HPV vaccination in males ........................................................ 4

3.5 Prevalence of any dose of HPV vaccination in males ..................................... 5

3.6 Dose-specific prevalence of HPV vaccination in males................................... 5

3.7 Prevalence of HPV vaccination when compared to private insurance............. 5

4. Discussion ..................................................................................................................... 6

5. Limitations ................................................................................................................... 9

6. Conclusion .................................................................................................................... 9

7. Acknowledgements .................................................................................................... 10

8. References ..................................................................................................................... I

9. Appendix .................................................................................................................... III

9.1 Table 1 ........................................................................................................... III

9.2 Table 2 ........................................................................................................... IV

9.3 Table 3 ......................................................................................... ................... V

9.4 Table 4 ........................................................................................................... VI

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management Health Sciences, Epidemiology
Palabra Clave	adolescent vaccination HPV vaccine human papillomavirus vaccine Insurance human papillomavirus Medicaid HPV National Immunization Survey-Teen human papillomavirus vaccination HPV vaccination adolescent immunization NIS-Teen
Committee Chair / Thesis Advisor	Bednarczyk, Robert, Emory University
Partnering Agencies	CDC

Última modificación

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Analysis of Dose-Specific Human Papillomavirus (HPV) Vaccination by Insurance Type Using the National Immunization Survey-Teen, 2015 ()	2018-04-19 12:56:29 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions