University of California, Davis School of Medicine, Division of Health Policy and Management, Department of Public Health Sciences, 4501 X Street, Suite 3003, Sacramento, CA 95817, USA.
University of California, Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, 2450 48th Street, Suite 1600, Sacramento, CA 95817, USA.
Vaccine. 2021 Jun 11;39(26):3528-3535. doi: 10.1016/j.vaccine.2021.04.055. Epub 2021 May 19.
Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11-17, of a large community-based primary care network.
Electronic health records and administrative data from a large primary care network from January 2017 - June 2018 for patients ages 11-17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake.
Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1-3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6-2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 - 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3-0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7-0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 - 1.0).
HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.
青少年的人乳头瘤病毒（HPV）疫苗接种率仍然相对较低。本研究的目的是检查与大社区初级保健网络中年龄在 11-17 岁的患者的 HPV 疫苗接种相关的患者和临床医生因素。
分析了 2017 年 1 月至 2018 年 6 月来自大型初级保健网络的电子健康记录和管理数据，这些患者年龄在 11-17 岁（n=10682），并对为他们看诊的 198 位初级保健临床医生进行了分析。混合效应逻辑回归模型检查了患者和临床医生因素与 HPV 疫苗接种率的关联。
大多数患者（63.0%）至少接种了一剂 HPV 疫苗，37.7%的患者完成了疫苗接种系列。在调整分析中，与未接种疫苗的患者相比，接种破伤风、白喉和百日咳（Tdap）疫苗的患者（OR=2.8，95%CI：2.1-3.9）和接受 5 次或更多次医疗就诊的患者（OR=1.9，95%CI：1.6-2.2），更有可能完成 HPV 疫苗系列接种。与白人患者相比，非裔美国人/黑人（OR=0.8，95%CI：0.6-1.0）和阿拉斯加原住民/美洲印第安人（OR=0.5，95%CI：0.3-0.9）患者完成 HPV 疫苗系列接种的可能性较小。与女孩相比，男孩也不太可能完成 HPV 疫苗系列接种（OR=0.7，95%CI：0.7-0.8）。此外，与儿科医生相比，有家庭/普通科初级保健临床医生的患者其患者完成疫苗接种的可能性较小（OR=0.8，95%CI：0.6-1.0）。
HPV 疫苗接种率因患者特征、卫生保健利用情况和初级保健临床医生专业不同而有所差异。这些发现可能为未来通过针对患者亚群和减少接种疫苗的错失机会，为提高青少年 HPV 疫苗接种率而制定基于证据的干预措施提供信息。
