265. Missed Opportunities For HPV Vaccination In Indiana: Geographic Variability

Abstract

Human papillomavirus (HPV) vaccination prevents infection with the types of HPV responsible for the large majority of cervical and anal cancers and precancers, as well as genital warts. Compared to 2016 U.S. national HPV vaccination rates for 13-17 year olds, Indiana lags substantially in HPV vaccine initiation, ranking 46th for females and last for males. However, rates likely vary substantially across Indiana’s 92 counties. The purpose of this study was to document variability across counties in missed opportunities to initiate HPV vaccination and to identify county-specific correlates of initiation rates among pre-adolescents ages 11-12, the targeted age range for on-time vaccination. The Indiana Immunization Surveillance System (IIS) provided 2017 county level data on HPV vaccine missed opportunity rates at ages 11-12. A missed opportunity was defined as a visit at which two vaccines were administered, but not HPV vaccine (in Indiana Tdap and MenACWY are required for middle school entry). County-specific socio-demographic and health data were derived from several sources, including the U.S. Census and countyhealthrankings.org, a program supported by the Robert Wood Johnson Foundation. Potential county-level correlates of missed opportunities included race, income, insurance status, population density, education, primary care provider (PCP) per capita, and rates of smoking, mammography screening, diabetes monitoring, and Pap testing. Data were analyzed via descriptive statistics and Pearson correlations. Each county was treated as an individual. The Mean HPV vaccine missed opportunity rate in Indiana for 11-12 years olds was 76% (SD=.07), but ranged widely from 58% to 94% across counties. There were significant negative correlations with mammography screening (r=-.34, p<.01) and diabetes monitoring (r=-.29, p<.01), indicating that counties with greater missed opportunities had lower mammography screening and diabetes monitoring rates. For the targeted ages of 11-12 there was wide variability in missed opportunities for HPV vaccination across the 92 Indiana counties, which emphasizes the need to not simply look at state-level HPV vaccination rates, but to examine small geographic regions. Variations in missed opportunity rates were associated with mammography screening rates and diabetes monitoring, which may reflect shared underlying issues related to access to health care across counties. There were no significant correlations to race, income, smoking, population density, per capita PCP, insurance status, and smoking rates. Clearly, then, more research is needed to fully explain variability across these smaller geographical regions. Further, interventions may be needed that target county-specific needs in increasing HPV vaccine uptake. Finally, the high rate of missed opportunities is consistent with previous research indicating the need for further education in promoting the HPV vaccine amongst primary care providers.