Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston.
JAMA Pediatr. 2024 Sep 1;178(9):932-939. doi: 10.1001/jamapediatrics.2024.2383.
Approximately 31 000 cases of human papillomavirus (HPV)-associated cancers are diagnosed annually in the US. The HPV vaccine can prevent more than 90% of these cancers, yet national uptake remains lower than the Healthy People 2030 target of 80% completion. To devise targeted interventions to increase the uptake of HPV vaccines, it is crucial to understand the vaccination rates across various health care settings.
To examine the association between health care facility type and adolescent HPV vaccine uptake and clinician recommendation for the vaccine in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study uses a complex sampling design of data from the 2020 National Immunization Survey-Teen. The study included adolescents aged 13 to 17 years. The data analysis was completed between March 1 and May 31, 2022.
Health care facility type classified as public, hospital-based, private, mixed (more than 1 type), and other facilities (eg, military health care facility; Women, Infants, and Children clinic; school-based health center; pharmacy).
Initiation of HPV vaccination was defined as the receipt of at least 1 dose of the HPV vaccine and completion as receipt of at least 2 or 3 doses, depending on age of initiation. Parent or guardian self-reported clinician recommendation was categorized as yes or no. Weighted, multivariable logistic regression models were used to estimate the odds of initiating and completing the HPV vaccine series and receiving clinician recommendation by health care facility type adjusted for adolescent and maternal characteristics.
A total of 20 162 adolescents (mean [SD] age, 14.9 [1.4] years; 51.0% male) were included. Clinician recommendation for the HPV vaccine was received by 81.4% of adolescents, and 75.1% initiated and 58.6% completed the HPV vaccine series. In the adjusted analyses, adolescents who received recommended vaccinations at public facilities had lower odds of initiating (adjusted odds ratio [AOR], 0.71; 95% CI, 0.58-0.88) and completing (AOR, 0.62; 95% CI, 0.51-0.76) HPV vaccination compared with those who received recommended vaccinations at private facilities. Similarly, adolescents who received recommended vaccinations at public facilities (AOR, 0.62; 95% CI, 0.51-0.77) had lower odds of receiving a clinician recommendation for the HPV vaccine compared with those who received recommended vaccinations at private facilities.
These findings reveal health disparities in HPV vaccination among adolescent populations served by public health care facilities, suggesting that a greater focus is needed on vaccine recommendations and uptake in public facilities.
在美国，每年约有 31000 例人乳头瘤病毒（HPV）相关癌症被诊断。HPV 疫苗可以预防超过 90%的此类癌症，但全国的接种率仍低于 2030 年健康人 80%完成目标。为了制定有针对性的干预措施来提高 HPV 疫苗的接种率，了解各种医疗保健环境中的疫苗接种率至关重要。
本研究旨在调查美国不同医疗机构类型与青少年 HPV 疫苗接种率和临床医生推荐 HPV 疫苗之间的关联。
设计、地点和参与者：这是一项使用 2020 年全国免疫调查-青少年数据的复杂抽样设计的横断面研究。研究对象为 13 至 17 岁的青少年。数据分析于 2022 年 3 月 1 日至 5 月 31 日进行。
医疗机构类型分为公立、医院、私立、混合（超过 1 种）和其他机构（例如，军事医疗机构；妇女、婴儿和儿童诊所；学校卫生中心；药店）。
HPV 疫苗接种的起始定义为至少接种 1 剂 HPV 疫苗，完成定义为至少接种 2 剂或 3 剂，具体取决于起始年龄。父母或监护人自我报告的临床医生推荐分为是或否。使用多变量 logistic 回归模型，根据青少年和母亲的特征，调整医疗机构类型后，估计 HPV 疫苗系列接种的起始和完成情况以及接受临床医生推荐的可能性。
共纳入 20162 名青少年（平均[SD]年龄 14.9[1.4]岁；51.0%为男性）。81.4%的青少年接受了 HPV 疫苗的临床推荐，75.1%的青少年接种了 HPV 疫苗，58.6%的青少年完成了 HPV 疫苗系列接种。在调整后的分析中，与在私立医疗机构接受推荐接种的青少年相比，在公立医疗机构接受推荐接种的青少年接种 HPV 疫苗的起始（调整后的优势比[OR]，0.71；95%CI，0.58-0.88）和完成（调整后的 OR，0.62；95%CI，0.51-0.76）的可能性较低。同样，与在私立医疗机构接受推荐接种的青少年相比，在公立医疗机构接受推荐接种的青少年接受 HPV 疫苗临床推荐的可能性较低（调整后的 OR，0.62；95%CI，0.51-0.77）。
这些发现揭示了在接受公共医疗保健机构服务的青少年人群中 HPV 疫苗接种的健康差异，表明需要更加关注公共机构的疫苗推荐和接种率。
