Abstract C084: Geographic variation in human papillomavirus (HPV) vaccination initiation and completion among adults in the United States
Authors: Boakye Eric Adjei , Wang Maggie , Jenkins Wiley D , Osazuwa-Peters Nosayaba , Babatunde Oluwole , Lee Min Jee , Kim Minjin 
Published: September 2020

Abstract
Background: Approximately 43,000 human papillomavirus (HPV)-associated cancers and 350,000 genital warts are diagnosed annually in the United States. The HPV vaccine can prevent HPV-associated cancers and genital warts. The Advisory Committee on Immunization Practices recommends routine HPV vaccination for adolescents between 11 and 12 years of age, and catch-up vaccination up to 45 years recently. Despite the availability, safety, and efficacy of HPV vaccines, uptake has been suboptimal compared to other routine vaccinations in adolescents, and even worse for adults in the catch-up group. As little is known about geographic variation in HPV vaccine uptake among adults, we explored how HPV vaccine initiation and completion rates among 18–34 year olds (both men and women) varies by geographic region. Methods: We analyzed data from 16 states (Alabama, Arkansas, Connecticut, Georgia, Hawaii, Massachusetts, Mississippi, Missouri, New Hampshire, Nebraska, North Carolina, South Carolina, South Dakota, Tennessee, Texas, and West Virginia) which conducted the adult HPV module survey during 2015–2017 Behavioral Risk Factor Surveillance System. Two variables were used to define geographic region: census region (South, Northeast and Midwest/west) and residential area (urban and rural). HPV vaccine initiation was defined as receipt of at least one dose of the vaccine and completion as receipt of three doses. Weighted, multivariable binary logistic regression models were used to assess the association between geographic region and HPV vaccine uptake, adjusting for demographic, socioeconomic, and healthcare utilization factors. Results: A total of 18,078 adults were included in the study, of whom 80% resided in the South. The overall HPV initiation and completion rates were 23.4% and 11.0%, respectively. Vaccine initiation was higher among those who resided in the Northeast (38.6%) followed by Midwest/west (23.8%) and lowest for those in the South (21.8%). But initiation rates was similar between those who reside in urban (24.1%) and rural (21.0%) areas. Completion rates followed the same trend as initiation for both census region and residential area. In the adjusted models, compared to adults residing in the South, those living in the Northeast were more likely to initiate (adjusted odds ratio: 2.14; 95 % CI: 1.81–2.53) and complete (1.80; 1.47–2.20) the HPV vaccine. There were no significant differences observed for initiation or completion by residential area. Conclusions: Both the South and the Northeast have low HPV vaccination initiation and completion rates compare to the Healthy People 2020 goal of 80%, but vaccine uptake were significantly lower in the South region. No difference in HPV vaccine uptake was observed between the rural and urban areas. This demonstrates the need to develop and implement interventions programs to reduce geographical disparities in HPV vaccine uptake and ultimately to improve HPV vaccine uptake, especially in the South region.
Citation Format: Eric Adjei Boakye, Maggie Wang, Wiley D Jenkins, Nosayaba Osazuwa-Peters, Oluwole Babatunde, Min Jee Lee, Minjin Kim. Geographic variation in human papillomavirus (HPV) vaccination initiation and completion among adults in the United States [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C084.