Trends in human papillomavirus (HPV) vaccination initiation among adolescents aged 13-17 by metropolitan statistical area (MSA) status, National Immunization Survey - Teen, 2013 - 2017

Abstract

Disparities in HPV vaccination coverage by metropolitan statistical area (MSA) status were observed in the 2016 and 2017 National Immunization Survey - Teen (NIS-Teen). In 2017, HPV vaccination initiation (≥1dose) coverage was 11 percentage points lower for adolescents living in non-MSAs (mostly rural areas) and 7 percentage points lower among those living in MSA, non-principal cities (suburban areas) compared to those living in MSA, principal cities (mostly urban areas). In order to understand how this disparity has changed over time, we examined trends in HPV vaccine initiation by MSA status from 2013 to 2017. Weighted linear regression by survey year was used to estimate annual percentage point changes in HPV vaccination initiation. The five-year average annual percentage point increases in HPV vaccination initiation coverage were 5.2 in mostly urban areas, 4.9 for suburban areas, and 5.2 for mostly rural areas. Despite increases in each MSA area, coverage in mostly rural areas was consistently and significantly lower than coverage in mostly urban areas. Coverage was significantly lower among teens living in mostly rural areas regardless of poverty status, sex, and race/ethnicity except among black, non-Hispanic adolescents. There was no significant change in the magnitude of the disparity between mostly urban areas and mostly rural areas over time (p = .98). A better understanding of the facilitators and barriers to HPV vaccination in mostly rural areas is needed to identify and implement targeted strategies to improve HPV vaccination coverage and reduce these disparities.

Keywords: Human papillomavirus (HPV) vaccine; adolescents; disparity; rural; trend; urban.

Figure 1.

Coverage with ≥1 HPV vaccine among adolescents aged 13–17 years by MSA status and nationally, NIS-teen, 2013–2017. Footnotes:AAPPC = Average annual percentage point change. *Statistically significant (p < .05) percent point increase compared to the previous year.† Statistically significant average annual increase/decrease

Figure 2.

(a). Disparities in HPV vaccination initiation among adolescents aged 13–17 years living in mostly urban vs. mostly rural areas, NIS-teen 2013–2017. Between 2013 and 2017, the estimated average annual percentage point change in the difference in coverage between mostly urban and mostly rural areas: 0.0, p = .98. (b). Disparities in HPV vaccination initiation among adolescents aged 13–17 years living in mostly urban vs. suburban areas, NIS-teen 2013–2017. Between 2013 and 2017, the estimated average annual percentage point change in the difference in coverage between mostly urban and suburban areas: 0.3, p = .50. (c). Disparities in HPV vaccination initiation among adolescents aged 13–17 years living in suburban vs. mostly rural areas, NIS-teen 2013–2017. Between 2013 and 2017, the estimated average annual percentage point change in the difference in coverage between suburban and mostly rural areas: −0.3, p = .59.

Figure 3.

(a). Disparities in ≥1 MenACWY vaccination coverage among adolescents aged 13–17 Years by MSA, NIS-teen, 2013–2017. Footnotes: * Statistically different from adolescents living in both mostly urban and suburban areas (p < .05). (b). Disparities in ≥1 MenACWY vaccination coverage among adolescents aged 13–17 years living in mostly urban vs. mostly rural areas, NIS-teen 2013–2017. Between 2013 and 2017, the estimated average annual percentage point change in the difference in coverage between mostly urban and mostly rural areas: −2.2, p < .01.

Figure 4.

Disparities in ≥1 Tdap vaccination coverage among adolescents aged 13–17 Years by MSA, NIS-teen, 2013–2017. Footnotes:* Statistically different from adolescents living in both mostly urban and suburban areas (p < .05).