Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, Missouri 63108, USA.
Am J Prev Med. 2010 May;38(5):525-33. doi: 10.1016/j.amepre.2010.01.018.
A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.
The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.
Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.
Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance=0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.
The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls.
人乳头瘤病毒（HPV）疫苗于 2006 年获得美国食品和药物管理局批准用于女性/女孩。自那时以来，有限的研究检查了青少年女孩中 HPV 疫苗的接种情况，没有研究检查 HPV 疫苗接种的地理差异。
本研究旨在检查人乳头瘤病毒（HPV）疫苗接种的地理差异，并检查疫苗接种的个体、县和州级相关因素。
使用来自六个美国州的 2008 年行为风险因素监测系统（BRFSS）和 2000 年美国人口普查的数据，对年龄在 13-17 岁的女孩进行了三水平随机截距多层逻辑回归模型拟合。
共纳入 1709 名女孩，这些女孩嵌套在 274 个县和六个州内。女孩主要为白人（70.6%）和有保险（74.5%）。总体而言，34.4%的女孩接种了疫苗。州（方差=0.134，SE=0.065）和县（方差=0.146，SE=0.063）之间存在显著的地理差异，这部分是由州和县的贫困水平解释的。独立于个体水平因素，贫困在州和县级水平上的影响不同：贫困程度较高的州的女孩接种疫苗的可能性较小，而贫困程度较高的县的女孩接种疫苗的可能性较大。家庭收入表现出与县一级贫困相似的模式：与收入最高的家庭的女孩相比，收入最低的家庭的女孩更有可能接种疫苗。
本研究结果表明 HPV 疫苗接种存在地理差异。尽管较高的州级贫困与较低的疫苗接种可能性相关，但较高的县级贫困和较低的家庭收入与较高的疫苗接种可能性相关。需要研究以更好地了解这些差异，并为增加所有合格女孩的疫苗接种提供信息。
