Human Papillomavirus Vaccination Among Young Adults Before and During the COVID-19 Pandemic

Abstract

Introduction In the US, the human papillomavirus (HPV) vaccine is routinely recommended as catch-up vaccination for adults aged 18 to 26 years who were not adequately vaccinated at a younger age.1 Before the COVID-19 pandemic started in March 2020, a steady increase in HPV vaccination coverage in this population was reported.2 However, coverage during the pandemic remains unknown. We compared national HPV vaccination coverage among young adults before and during the pandemic and assessed recent vaccination rates among racial, ethnic, and sexual minority groups and other sociodemographic subgroups. Methods We analyzed data for participants aged 18 to 26 years in the 2018, 2019, and 2022 National Health Interview Survey (NHIS), a nationally representative survey of a civilian noninstitutionalized population.3 Trained interviewers administered the survey after obtaining participants’ informed consent. Sociodemographic information and HPV vaccination status were self-reported; vaccination status was not collected in 2020 and 2021. The Medical University of South Carolina Institutional Review Board deemed this cross-sectional survey study exempt from review and informed consent because it used deidentified publicly available data. We followed the AAPOR reporting guideline.4 We defined coverage as receipt of 1 or more doses of HPV vaccine before age 27 years. Proportions and representative population counts were estimated using NHIS sampling weights. Multivariable models estimated prevalence ratios. Statistical significance was tested at P < .05. All analyses were performed with SAS 9.4, specifically SURVEY procedures to incorporate sampling weights and adjust for the complex survey design. Results A total of 2159 (estimated 33.6 million) adults aged 18 to 26 years (50.5% females [16.9 million], 49.5% males [16.6 million]; 23.0% Hispanic, 12.9% non-Hispanic Black, 53.4% non-Hispanic White, 10.7% other race and ethnicity [non-Hispanic American Indian or Alaska Native, non-Hispanic Asian, any other groups, and other single and multiple races]) with HPV vaccination information were identified in 2022. Overall, 47.4% reported receiving 1 or more vaccine doses. Unlike the increase in HPV vaccination rate from 2018 to 2019 (39.9% to 47.0%; P < .001), no significant change was observed from 2019 to 2022 (Figure). In 2022, more females than males were vaccinated (57.2% vs 37.3%; P < .001). In 2022, coverage among Hispanic, non-Hispanic Black, and participants of other races and ethnicities was similar compared with non-Hispanic White individuals (Table). Coverage was higher among lesbian, gay, bisexual, and other sexual orientation (LGB+) group than heterosexual females (70.6% vs 53.6%; P < .001) and higher among gay, bisexual, and other sexual orientation (GB+) group than heterosexual males (52.7% vs 36.2%; P = .02). Coverage was lower among uninsured males and females (20.0% and 33.9%; P < .001) vs their insured counterparts (40.9% and 60.6%; P < .001).