School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA.
Center for Population Health Research, University of Montana, Missoula, MT, USA.
Hum Vaccin Immunother. 2022 Jan 31;18(1):2016304. doi: 10.1080/21645515.2021.2016304. Epub 2022 Feb 4.
Human papillomavirus (HPV) vaccination rates are lower in rural versus urban areas of the United States. Our objective was to identify the types of vaccination clinic settings where missed opportunities for HPV vaccine series initiation most frequently occurred in Montana, a large, primary rural U.S. state. We analyzed a limited dataset from Montana's immunization information system for adolescents who turned 11 years old in 2014-2017. Vaccination visits where the HPV vaccine was due but not administered were missed opportunities. We compared missed opportunities across six types of clinic settings, and calculated adjusted relative risks (RR) using a generalized estimating equation model. Among n = 47,622 adolescents, 53.9% of 71,447 vaccination visits were missed opportunities. After adjusting for sex, age, and rurality of clinic location, receiving vaccines in public health departments was significantly associated with higher risk of missed opportunities (aRR = 1.25, 95% confidence interval = 1.22-1.27, vs. private clinics). Receipt of vaccines in Indian Health Services and Tribal clinics was associated with fewer missed opportunities (aRR = 0.72, 95% CI: 0.69-0.75, vs. private clinics). Our results indicate the need for interventions to promote HPV vaccine uptake in public health departments, which are a critical source of immunization services in rural and medically underserved areas of the U.S.
人乳头瘤病毒（HPV）疫苗接种率在美国农村地区低于城市地区。我们的目标是确定在蒙大拿州（美国一个大型农村州），HPV 疫苗系列接种最常错过的接种诊所类型。我们分析了蒙大拿州青少年免疫信息系统中的一个有限数据集，这些青少年在 2014-2017 年满 11 岁。HPV 疫苗应接种但未接种的接种访问是错过的机会。我们比较了六种诊所类型的错过机会，并使用广义估计方程模型计算了调整后的相对风险（RR）。在 n = 47622 名青少年中，71447 次接种访问中有 53.9%是错过的机会。在调整了性别、年龄和诊所位置的农村性后，在公共卫生部门接种疫苗与错过机会的风险显著增加相关（调整后的 RR = 1.25，95%置信区间 = 1.22-1.27，与私人诊所相比）。在印第安人健康服务和部落诊所接种疫苗与错过机会较少相关（调整后的 RR = 0.72，95%置信区间：0.69-0.75，与私人诊所相比）。我们的结果表明，需要采取干预措施来促进公共卫生部门 HPV 疫苗的接种，这是美国农村和医疗服务不足地区免疫服务的重要来源。
