Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Immunization Services Division.
Leidos Health, Inc., Reston, VA, USA.
Hum Vaccin Immunother. 2020 Mar 3;16(3):554-561. doi: 10.1080/21645515.2019.1671765. Epub 2019 Oct 29.
Disparities in HPV vaccination coverage by metropolitan statistical area (MSA) status were observed in the 2016 and 2017 National Immunization Survey - Teen (NIS-Teen). In 2017, HPV vaccination initiation (≥1dose) coverage was 11 percentage points lower for adolescents living in non-MSAs (mostly rural areas) and 7 percentage points lower among those living in MSA, non-principal cities (suburban areas) compared to those living in MSA, principal cities (mostly urban areas). In order to understand how this disparity has changed over time, we examined trends in HPV vaccine initiation by MSA status from 2013 to 2017. Weighted linear regression by survey year was used to estimate annual percentage point changes in HPV vaccination initiation. The five-year average annual percentage point increases in HPV vaccination initiation coverage were 5.2 in mostly urban areas, 4.9 for suburban areas, and 5.2 for mostly rural areas. Despite increases in each MSA area, coverage in mostly rural areas was consistently and significantly lower than coverage in mostly urban areas. Coverage was significantly lower among teens living in mostly rural areas regardless of poverty status, sex, and race/ethnicity except among black, non-Hispanic adolescents. There was no significant change in the magnitude of the disparity between mostly urban areas and mostly rural areas over time ( = .98). A better understanding of the facilitators and barriers to HPV vaccination in mostly rural areas is needed to identify and implement targeted strategies to improve HPV vaccination coverage and reduce these disparities.
在 2016 年和 2017 年的国家免疫调查-青少年（NIS-青少年）中，观察到大都市统计区（MSA）地位的 HPV 疫苗接种覆盖率存在差异。2017 年，居住在非 MSA（主要是农村地区）的青少年 HPV 疫苗接种起始（≥1 剂）覆盖率比居住在 MSA、非主要城市（郊区）的青少年低 11 个百分点，与居住在 MSA、主要城市（主要是城市地区）的青少年相比。为了了解这种差异是如何随时间变化的，我们检查了 2013 年至 2017 年按 MSA 地位划分的 HPV 疫苗接种起始趋势。按调查年份进行加权线性回归，以估计 HPV 疫苗接种起始的年度百分比变化。HPV 疫苗接种起始率的五年平均年增长率在城市地区为 5.2%，郊区为 4.9%，农村地区为 5.2%。尽管每个 MSA 地区的覆盖率都有所增加，但农村地区的覆盖率始终明显低于城市地区。无论贫困状况、性别和种族/民族如何，生活在农村地区的青少年的覆盖率都明显较低，除了非裔美国青少年和非西班牙裔青少年。在农村地区，主要城市地区和农村地区之间的差距在时间上并没有明显变化（=.98）。需要更好地了解农村地区 HPV 疫苗接种的促进因素和障碍，以确定并实施有针对性的策略，提高 HPV 疫苗接种率，减少这些差异。
