School of Social Work, Boston College, McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
Department of Economics, Boston College, Chestnut Hill, MA, USA.
Cancer Causes Control. 2021 Jul;32(7):783-790. doi: 10.1007/s10552-021-01430-4. Epub 2021 Apr 17.
We examined associations between the 2010 Affordable Care Act (ACA) provisions, 2011 Advisory Committee on Immunization Practices (ACIP) recommendation, and 2014 ACA-related health insurance reforms with HPV vaccine initiation rates by sex and health insurance type.
Using 2009-2015 public and private health insurance claims for 551,764 males and females aged 9-26 years (referred to as youth) from Maine, New Hampshire, and Massachusetts, we conducted linear regression models to examine the associations between three policy changes and HPV vaccine initiation rates by sex and health insurance type.
In 2009, HPV vaccine initiation rates for males and females were 0.003 and 0.604 per 100 enrollees, respectively. Among males, the 2010 ACA provisions and ACIP recommendation were associated with significant increases in HPV vaccine uptake among those with private plans (0.207 [0.137, 0.278] and 0.419 [0.353, 0.486], respectively) and Medicaid (0.157 [0.083, 0.230] and 0.322 [0.257, 0.386], respectively). Among females, the 2010 ACA provisions were associated with significant increases in HPV vaccine uptake among Medicaid enrollees only (0.123 [0.033, 0.214]). The ACA-related health insurance reforms were associated with significant increases in HPV vaccine uptake for male and female Medicaid enrollees (0.257 [0.137, 0.377] and 0.214 [0.102, 0.327], respectively), but no differences among privately insured youth. By 2015, there were no differences in HPV vaccine initiation rates between males (0.278) and females (0.305).
Both ACA provisions and the ACIP recommendation were associated with significant increases in HPV vaccine initiation rates among privately and publicly insured males in three New England states, closing the gender gap. In contrast, females and youth with private insurance did not exhibit the same changes in HPV vaccine uptake over the study period.
我们研究了 2010 年平价医疗法案（ACA）条款、2011 年免疫实践咨询委员会（ACIP）建议，以及 2014 年与 ACA 相关的医疗保险改革与按性别和医疗保险类型划分的 HPV 疫苗接种率之间的关系。
使用 2009-2015 年缅因州、新罕布什尔州和马萨诸塞州 551764 名 9-26 岁男女性青年的公共和私人医疗保险索赔数据，我们通过线性回归模型检验了三项政策变化与 HPV 疫苗接种率之间的关系，这些变化按性别和医疗保险类型进行了划分。
2009 年，男性和女性的 HPV 疫苗接种率分别为每 100 名参保者 0.003 和 0.604。在男性中，2010 年 ACA 条款和 ACIP 建议与私人计划（0.207[0.137,0.278]和 0.419[0.353,0.486]）和医疗补助（0.157[0.083,0.230]和 0.322[0.257,0.386]）中 HPV 疫苗接种率的显著增加相关。在女性中，2010 年 ACA 条款仅与医疗补助参保者 HPV 疫苗接种率的显著增加相关（0.123[0.033,0.214]）。与 ACA 相关的医疗保险改革与男性和女性医疗补助参保者 HPV 疫苗接种率的显著增加相关（0.257[0.137,0.377]和 0.214[0.102,0.327]），但在私人保险的青年中没有差异。到 2015 年，男性（0.278）和女性（0.305）的 HPV 疫苗接种率之间没有差异。
在三个新英格兰州，ACA 条款和 ACIP 建议都与私人和公共保险男性 HPV 疫苗接种率的显著增加有关，缩小了性别差距。相比之下，在研究期间，女性和私人保险的青年在 HPV 疫苗接种率方面没有表现出相同的变化。
