Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, USA.
J Rural Health. 2023 Mar;39(2):499-507. doi: 10.1111/jrh.12724. Epub 2022 Nov 17.
Human papillomavirus (HPV) infection contributes to vaccine-preventable malignancies. Rural populations experience lower HPV vaccination rates despite similar rates of other childhood vaccinations. Individual- and clinic-level characteristics likely contribute to this disparity, but little is known about the separate roles of each. We compared clinic-level HPV vaccination rates among rural versus urban primary care clinics, identified factors associated with HPV vaccination, and separately assessed the impact of individual- and clinic-level characteristics on rural disparities in HPV vaccination.
This cross-sectional study included 537 Oregon primary care clinics participating in the Vaccines for Children (VFC) program during 2019. Vaccination status was assessed using Oregon's ALERT Immunization Information System and included HPV vaccine ≥ 1 dose for ages 11 and 12; HPV vaccination up to date (UTD) for ages 13-17, and coadministration with tetanus, diphtheria, and acellular pertussis (Tdap). Rural versus urban clinic-level outcomes were assessed using negative binomial regression.
Participating clinics were 24.5% rural and 75.6% urban. Family medicine clinics comprised 71.1%; pediatrics, 16.9%; and mixed, 12.1%. Across clinics, the average proportion of patients qualifying for VFC was 43%, and non-White patients were 14.1%. The mean rate of HPV vaccine ≥1 dose was lower among rural clinics (46.9% vs 51.1%, P = .039), as was vaccination UTD (40.5% vs 49.9%, P < .001). Adjusting for differences in individual- and clinic-level characteristics, rural disparities were no longer statistically significant.
Both individual- and clinic-level characteristics play a role in rural disparities in HPV vaccination, and modifiable clinic-level differences may be opportune targets to address these disparities.
人乳头瘤病毒（HPV）感染可导致可通过疫苗预防的癌症。尽管农村地区儿童疫苗接种率与其他地区相似，但农村地区 HPV 疫苗接种率却较低。个人和诊所层面的特征可能导致了这一差异，但对于这些差异的单独作用知之甚少。我们比较了农村和城市初级保健诊所的 HPV 疫苗接种率，确定了与 HPV 疫苗接种相关的因素，并分别评估了个人和诊所层面特征对农村 HPV 疫苗接种率差异的影响。
本横断面研究包括 2019 年参加疫苗接种儿童计划（VFC）的俄勒冈州 537 家初级保健诊所。使用俄勒冈州的警报免疫信息系统评估接种状况，包括 11 岁和 12 岁时至少接种 1 剂 HPV 疫苗；13-17 岁时 HPV 疫苗接种完成（UTD），并与破伤风、白喉和无细胞百日咳（Tdap）联合使用。使用负二项回归评估农村与城市诊所层面的结果。
参与的诊所中有 24.5%是农村诊所，75.6%是城市诊所。家庭医学诊所占 71.1%；儿科占 16.9%；混合诊所占 12.1%。在所有诊所中，符合 VFC 条件的患者平均比例为 43%，非白人患者占 14.1%。农村诊所 HPV 疫苗至少接种 1 剂的比例较低（46.9%对 51.1%，P=0.039），疫苗 UTD 接种率也较低（40.5%对 49.9%，P<0.001）。调整个人和诊所层面特征的差异后，农村地区的差异不再具有统计学意义。
个人和诊所层面的特征都对 HPV 疫苗接种的农村地区差异有影响，并且可改变的诊所层面的差异可能是解决这些差异的恰当目标。
