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Ethn Health. 2018 Jan 18:1-15. doi: 10.1080/13557858.2018.1427703. [Epub ahead of print]

Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-Affordable Care Act era.

Author information

1
a Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health , Boston , MA , USA.
2
b Department of Social and Behavioral Sciences , University of California San Francisco School of Nursing , San Francisco , CA , USA.
3
c Department of Health Behavior and Biological Sciences , University of Michigan School of Nursing , Ann Arbor , MI , USA.
4
d Center for Women's Health Research and Innovation, Division of General Internal Medicine, Department of Medicine , University of Pittsburgh School of Medicine , Pittsburgh , PA , USA.
5
e Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System , Pittsburgh , USA.

Abstract

OBJECTIVE:

To ascertain the magnitude and potential mechanisms of racial/ethnic disparities in initiating and completing the 3-dose human papillomavirus (HPV) vaccine among U.S. women in the post-Affordable Care Act era.

DESIGN:

Using 2015 National Health Interview Survey data, we used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between race/ethnicity and HPV vaccination initiation and completion among black, Latina, Asian, and white U.S. women aged 18-31 years, adjusting for age and geographic region. We also examined the role of socioeconomic and health care factors in potentially explaining racial/ethnic disparities in HPV vaccine uptake and stratified our analyses by age (ages 18-22 and 23-31 years).

RESULTS:

The prevalence of HPV vaccination initiation and completion among U.S. women aged 18-31 years overall was 35.4% and 22.7%, respectively. We observed no statistically significant difference in the odds of HPV vaccination initiation or completion by race/ethnicity among women aged 18-22 years, adjusting for age and geographic region. Among women aged 23-31 years, Latina ([odds ratio=] 0.59; [95% confidence interval:] 0.47, 0.76) and Asian (0.51; 0.34, 0.75) women had significantly lower adjusted odds of initiating HPV vaccination compared to white women. Further, relative to white women, black (0.46; 0.32, 0.67), Latina (0.45; 0.32, 0.64), and Asian (0.46; 0.28, 0.78) women had significantly lower adjusted odds of completing HPV vaccination. Adding socioeconomic factors to the models attenuated the HPV vaccination initiation adjusted odds ratios for Latina vs. white women and the HPV vaccination completion adjusted odds ratios for both black and Latina vs. white women. The inclusion of health care factors into the models did not further attenuate these odds ratios.

CONCLUSION:

Policies and programs that promote socioeconomic equity may mitigate HPV vaccination disparities between black and Latina women and white women. Additional research is needed to identify the drivers of HPV vaccination disparities between subgroups of Asian women and white women.

KEYWORDS:

Human papillomavirus vaccination; health disparities; race/ethnicity; social determinants of health; women; young adults

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