Disparities in healthcare access and utilization and human papillomavirus (HPV) vaccine initiation in the United States

Abstract

Currently in the United States, Human Papillomavirus (HPV) vaccination coverage among eligible individuals is lower compared to coverage goals of 80% set by the HealthyPeople 2030 initiative. In this study, we used the National Health and Nutrition Examination Survey (NHANES) 2015–2016 and 2017–2018 datasets to determine the association between HPV vaccine initiation among individuals of ages 9 to 26 years and their patterns of healthcare access and utilization. In particular, we examined the following healthcare characteristics: 1) having a routine place of healthcare, 2) having health insurance coverage, 3) frequency of healthcare visits per year, and 4) type of routine place of healthcare (outpatient primary care vs. ED, etc.). We fit independent multivariable logistic regression models for each NHANES dataset and controlled for sociodemographic characteristics and interactions with healthcare access and utilization characteristics. Our findings suggest that HPV vaccine initiation is positively associated with having a routine place of healthcare (2015–2016: aOR 1.92, 95% CI 1.25–2.95; 2017–2018: aOR 1.99, 95% CI 1.07–3.68). Relatedly, HPV vaccine initiation is negatively associated with never having received healthcare in the past year (2015–2016: aOR 0.61, 95% CI 0.41–0.90; 2017–2018: aOR 0.45, 95% CI 0.27–0.75). The results of this study suggest that interventions to promote HPV vaccination should include strategies that promote access to and utilization of routine health care services. Our findings are particularly salient in light of the drop in HPV vaccine initiation and healthcare access and utilization among adolescents during the COVID-19 pandemic.