Abstract B90: What do current vaccination patterns tell us about the future of geographic and racial disparities in human papillomavirus (HPV)-related cancers?
Authors: Moss Jennifer L. , Reiter Paul L. , Brewer Noel T. 
Published: October 2015

Abstract
Background: Human papillomavirus (HPV) vaccine can prevent several types of cancer, including cervical, anal, vaginal, and vulvar cancer. Widespread coverage with HPV vaccine could reduce disparities in the incidence and mortality rates of these cancers. However, preliminary evidence has shown that HPV vaccination among girls is highest in U.S. states with the lowest rates of cervical cancer mortality. We expanded on this finding and tested the hypothesis that states with higher risks of HPV-associated cancers would have lower HPV vaccine coverage levels.
Methods: We gathered state-level data on HPV-related cancer risk and HPV vaccine initiation coverage for girls and boys, separately, and HPV vaccine follow-through (i.e., receipt of 3 doses among those initiating the series) for girls only. In addition, we gathered data on states' demographic composition and contact with the healthcare system. Data came from high-quality, national sources, and most data were from 2012. We calculated Pearson correlations for ecological relationships between (a) vaccination levels and (b) cancer rates, demographic composition, and contact with the healthcare system.
Results: HPV vaccine initiation among girls was lower in states with higher levels of cervical cancer incidence and mortality (r=-.29 and -.46, respectively). In addition, girls' initiation was lower in states with higher proportions of non-Hispanic black residents (r=-.28) and lower proportions of higher income residents (r=.32).
HPV vaccine follow-through among girls was lower in states with higher levels of cervical cancer mortality (r=-.30) and higher in states with greater levels of adolescents' contact with the healthcare system.
HPV vaccine initiation among boys was lower in states with higher proportions of non-Hispanic white residents and lower proportions of residents of “other” race/ethnicity. HPV vaccine initiation among boys was not associated with states' HPV-related cancer incidence or mortality.
Conclusions: HPV vaccine coverage for girls was lower in states with higher HPV-related cancer risk. As initiation among boys and girls was highly correlated, it is possible that the pattern seen among girls could develop as vaccination among boys becomes more widely accepted and coverage increases. Public health efforts should concentrate on geographic areas with higher cancer burden. Strengthening adolescent preventive healthcare use may be particularly important to increase vaccine follow-through. Cost-effectiveness analyses may overestimate the benefits of current vaccination coverage and underestimate the benefits of increasing coverage. The current patterns of HPV vaccination, especially among girls, may not be adequate to reverse the current geographic and racial/ethnic disparities in HPV-related cancer incidence and mortality.
Citation Format: Jennifer L. Moss, Paul L. Reiter, Noel T. Brewer. What do current vaccination patterns tell us about the future of geographic and racial disparities in human papillomavirus (HPV)-related cancers? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B90.