Dubiel Lillian J, Vinekar Kavita S, Than Claire T, Chawla Neetu, Hoggatt Katherine J, Yano Elizabeth M, Danan Elisheva R
Department of Ob/Gyn, Duke University Medical Center, Durham, NC 27710, USA.
Department of Obstetrics & Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia 19107, PA, USA.
Mil Med. 2025 Apr 23;190(5-6):e1152-e1158. doi: 10.1093/milmed/usae490.
Human papillomavirus (HPV) infection is a major risk factor for the development of multiple cancers. Active duty service members have higher rates of HPV infection than civilians, while Veterans are diagnosed with a disproportionately high burden of HPV-associated cancers compared to civilians without prior service. While a highly effective HPV vaccine has been available for over a decade, vaccination rates in the United States remain suboptimal. The objective of this study was to investigate HPV vaccination rates among male and female Veterans compared with their non-Veteran counterparts.
We performed a secondary analysis of cross-sectional National Health Interview Survey (NHIS) data pooled from 2015 to 2018 to analyze HPV vaccination rates for respondents aged 18-45 years. We used multivariable logistic regression to compare HPV vaccination rates between Veterans and non-Veterans stratified by sex while controlling for sociodemographic factors, including age, race/ethnicity, education level, income, insurance coverage, and VA coverage. All analyses used NHIS survey weights to produce national estimates.
Among 45,493 respondents aged 18 to 45 years, vaccination rates were low across all groups: 9.6% of male Veterans and 8.4% of male non-Veterans (P = .21) had received at least one HPV immunization, whereas 32.0% of female Veterans and 25.1% of female non-Veterans (P = .02) were immunized. After controlling for sociodemographics, both male Veterans (AOR 1.79; 95%CI 1.31, 2.44) and female Veterans (AOR 1.56; 95%CI 1.1, 2.21) exhibited higher odds of HPV vaccination compared to their non-Veteran counterparts. VA coverage was also independently associated with higher odds of HPV vaccination among female Veterans (AOR 2.39; 95%CI 1.10, 5.21).
Veterans of both sexes are more likely to be vaccinated than their non-Veteran civilian counterparts. However, vaccination rates overall remain low. To our knowledge, ours is the first study of its kind to establish HPV vaccination rates among female Veterans. These findings underscore the important role of DoD and VA health care systems in improving HPV vaccine uptake and mitigating HPV-associated cancer risk among Veterans.
人乳头瘤病毒（HPV）感染是多种癌症发生的主要风险因素。现役军人的HPV感染率高于平民，而与无服役经历的平民相比，退伍军人被诊断出患HPV相关癌症的负担过高。尽管一种高效的HPV疫苗已经问世十多年，但美国的疫苗接种率仍不理想。本研究的目的是调查退伍军人与非退伍军人中男性和女性的HPV疫苗接种率。
我们对2015年至2018年汇总的全国健康访谈调查（NHIS）横断面数据进行了二次分析，以分析18至45岁受访者的HPV疫苗接种率。我们使用多变量逻辑回归来比较退伍军人与非退伍军人按性别分层的HPV疫苗接种率，同时控制社会人口学因素，包括年龄、种族/族裔、教育水平、收入、保险覆盖范围和退伍军人事务部（VA）覆盖范围。所有分析均使用NHIS调查权重来得出全国估计数。
在45493名18至45岁的受访者中，所有组的疫苗接种率都很低：9.6%的男性退伍军人和8.4%的男性非退伍军人（P = 0.21）至少接种过一剂HPV疫苗，而32.0%的女性退伍军人和25.1%的女性非退伍军人（P = 0.02）接种过疫苗。在控制了社会人口学因素后，男性退伍军人（调整后比值比[AOR]为1.79；95%置信区间[CI]为1.31，2.44）和女性退伍军人（AOR为1.56；95%CI为1.1，2.21）与非退伍军人相比，HPV疫苗接种的几率更高。VA覆盖范围也与女性退伍军人中更高的HPV疫苗接种几率独立相关（AOR为2.39；95%CI为1.10，5.21）。
退伍军人无论男女比非退伍平民更有可能接种疫苗。然而，总体疫苗接种率仍然很低。据我们所知，我们的研究是同类研究中首次确定女性退伍军人的HPV疫苗接种率。这些发现强调了国防部和退伍军人事务部医疗系统在提高退伍军人HPV疫苗接种率和降低HPV相关癌症风险方面的重要作用。
