Adekanmbi Victor, Guo Fangjian, Hsu Christine D, Shan Yong, Kuo Yong-Fang, Berenson Abbey B
Center for Interdisciplinary Research in Women's Health, School of Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA.
Department of Obstetrics and Gynecology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
Vaccines (Basel). 2023 Apr 10;11(4):820. doi: 10.3390/vaccines11040820.
In the United States, the human papillomavirus (HPV) vaccine is approved for use in individuals up to age 45. Individuals 15 years and older require three doses of the vaccine to complete the recommended dosing series. Incomplete HPV vaccination rates (i.e., one or two doses) among those over age 26, however, remain high. This study examined the independent effects of individual- and neighborhood-level factors on incomplete HPV vaccination rates in the United States (U.S.) among those aged 27-45 years. This retrospective cohort study used administrative data from Optum's de-identified Clinformatics Data Mart Database to identify individuals aged 27-45 years who received one or more doses of HPV vaccine between July 2019 and June 2022. Multilevel multivariable logistic regression models were applied to the data on 7662 individuals identified as being fully or partially vaccinated against HPV, nested within 3839 neighborhoods across the U.S. Approximately half of the patients in this study (52.93%) were not completely vaccinated against HPV. After adjusting for all other covariates in the final model, being older than 30 years old decreased the odds of not completing the HPV vaccine series. Participants living in South-region neighborhoods of the U.S. had enhanced odds of not completing the vaccine series compared with those residing in Northeast-region neighborhoods (aOR 1.21; 95% CrI 1.03-1.42). There was significant clustering of incomplete HPV vaccination rates at the neighborhood level. This study revealed that individual- and neighborhood-level factors were associated with the risk of not completing the HPV vaccine series among individuals aged 27-45 years in the U.S. Interventions to improve HPV vaccination series completion rates for this age group should take into consideration both individual and contextual factors.
在美国，人乳头瘤病毒（HPV）疫苗被批准用于45岁及以下人群。15岁及以上的个体需要接种三剂疫苗才能完成推荐的接种程序。然而，26岁以上人群中HPV疫苗接种不完全率（即接种一剂或两剂）仍然很高。本研究调查了个体层面和社区层面因素对美国27至45岁人群HPV疫苗接种不完全率的独立影响。这项回顾性队列研究使用了Optum的去识别化临床信息数据集市数据库中的管理数据，以识别在2019年7月至2022年6月期间接种了一剂或多剂HPV疫苗的27至45岁个体。对7662名被确定为已完全或部分接种HPV疫苗的个体数据应用了多水平多变量逻辑回归模型，这些个体嵌套在美国3839个社区中。本研究中约一半的患者（52.93%）未完全接种HPV疫苗。在最终模型中对所有其他协变量进行调整后，年龄超过30岁会降低未完成HPV疫苗接种程序的几率。与居住在东北地区社区的参与者相比，居住在美国南部地区社区的参与者未完成疫苗接种程序的几率更高（调整后比值比1.21；95%可信区间1.03 - 1.42）。在社区层面，HPV疫苗接种不完全率存在显著的聚集现象。本研究表明，个体层面和社区层面因素与美国27至4岁人群未完成HPV疫苗接种程序的风险相关。提高该年龄组HPV疫苗接种完成率的干预措施应同时考虑个体因素和背景因素。
