Department of Epidemiology and Biostatistics, City University of New York (CUNY) School of Public Health, New York, NY, United States of America.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Prev Med. 2021 Jul;148:106536. doi: 10.1016/j.ypmed.2021.106536. Epub 2021 Mar 30.
The human papillomavirus (HPV) vaccine protects against cancers caused by HPV. The study objective was to examine the effect of the Affordable Care Act (ACA) dependent child coverage provision on HPV vaccination initiation, HPV vaccine completion, HPV infection, and health insurance coverage among young women. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2172 female participants were included. The impact of the dependent coverage provision on the four outcomes was examined using difference-in-difference analyses with linear probability regressions, controlling for race/ethnicity, age, income, head of household education, and family employment. ACA exposure group was operationalized by age, with those targeted by the dependent coverage provision (ages 19-25) serving as the intervention group and those similar in age but not targeted (ages 18 and 26) serving as the control group. From 2007 to 2016, HPV vaccine initiation, HPV vaccine completion, and health insurance prevalence increased and HPV infection prevalence decreased. In the difference-in-difference adjusted models, ACA exposure was not associated with HPV vaccine initiation (0.045 percentage points [95% CI -0.087, 0.178]), completion (-0.044 percentage points [95% CI -0.152, 0.063]), HPV 16/18 infection (-0.051 percentage points [95% CI -0.123, 0.021]), or health insurance (0.065 percentage points [95% CI -0.032, 0.162]) among women aged 19 to 25. The dependent coverage provision may not have addressed relevant barriers to HPV vaccination. However, given that the effect of the dependent coverage provision on HPV vaccination and health insurance has been demonstrated previously, small sample size is a concern.
人乳头瘤病毒（HPV）疫苗可预防 HPV 引起的癌症。本研究旨在检验平价医疗法案（ACA）中儿童保险覆盖条款对年轻女性 HPV 疫苗接种起始率、HPV 疫苗全程接种率、HPV 感染率和医疗保险覆盖率的影响。研究使用了国家健康和营养调查（NHANES）的横断面数据，共纳入了 2172 名女性参与者。通过线性概率回归的差分分析，控制了种族/民族、年龄、收入、家庭主要负责人的教育程度和家庭就业状况，检验了依赖保险覆盖条款对四个结果的影响。ACA 暴露组的划分依据是年龄，19-25 岁的目标人群为干预组，年龄相似但不是目标人群（18 岁和 26 岁）为对照组。2007 年至 2016 年，HPV 疫苗接种起始率、HPV 疫苗全程接种率和医疗保险覆盖率增加，HPV 感染率下降。在调整后的差异分析模型中，ACA 暴露与 HPV 疫苗接种起始率（0.045 个百分点[95%CI-0.087，0.178]）、完成率（0.044 个百分点[95%CI-0.152，0.063]）、HPV16/18 感染率（0.051 个百分点[95%CI-0.123，0.021]）或医疗保险覆盖率（0.065 个百分点[95%CI-0.032，0.162]）均无相关性，19-25 岁女性中。依赖保险覆盖条款可能没有解决 HPV 疫苗接种的相关障碍。然而，鉴于之前已经证明了依赖保险覆盖条款对 HPV 疫苗接种和医疗保险的影响，样本量小是一个关注点。
