Investigation of Disparities in Cervical Cancer Prevention in the United States: HPV Vaccination in 18-30 Year Old Women

Background and Purpose: In 2011, an estimated 12,710 women in the United States suffered from cervical cancer and 4,290 died from the disease. Most of the disease burden due to this cancer is avoidable – the etiology and slow progression of the cancer provide opportunities for primary and secondary prevention. Despite progress in screening for the disease, some racial/ethnic minority women (Hispanics and Blacks) and women of low socioeconomic status still experience higher incidence and mortality from cervical cancer.  New vaccines to prevent high-risk types of HPV represent an important opportunity for cervical cancer prevention.  However, since not all women have benefitted equally from cervical cancer screening, there is a possibility that HPV vaccination will not reduce, but instead widen racial/ethnic and socioeconomic disparities in cervical cancer risk. Guided by the Behavioral Model of Health Care Utilization, this study identifies barriers and facilitators of HPV vaccination among U.S. females aged 18-30.

Methods: Research questions were answered using the 2010 National Health Interview Survey (NHIS) (N=3,129). To understand the relationship between HPV vaccine utilization and barriers/facilitators, a multivariate logistic regression was conducted. The regression used “ever had HPV vaccine” as the outcome and the following predictors of vaccination: race/ethnicity, age, marital status, family income, education, any live birth, insurance status, hospitalization history, annual flu shot, annual PAP screen, and region of residence. Special statistical procedures were used to control for the complex survey design. Results are presented as odds ratios (OR). The pre-determined alpha level of significance was 0.05.

Results: The 2010 NHIS had 3,129 females aged 18-30 years old, representing about 27 million females. Significant factors associated with lower HPV vaccine utilization were: Hispanic (vs. non-Hispanic White, OR=0.53), non-Hispanic Black (vs. non-Hispanic White, OR=0.63), any live birth (OR=0.79), no health insurance (OR=0.48), and residing in the Southern U.S. (vs. West, OR=0.49). Significant factors associated with higher use of HPV vaccine were: younger age (18-22 years, OR=2.8), never being married (OR=3.5), annual flu vaccination (OR=2.4), and annual PAP screen (OR=1.8).

Discussion/Implications: This study suggests that race, insurance status, and region of residence are barriers to HPV vaccination. By 2010 Hispanic and non-Hispanics Black women were 47% and 37% less likely to have received HPV vaccination than non-Hispanic White women. Similarly, controlling for race/ethnicity, females without health insurance or living in the Southern U.S. were 52% and 51% less likely to have received HPV vaccine than those with private health insurance or residing in the West.  Moreover, the research suggests that preventative health behavior facilitates use of the HPV vaccine. Women receiving an annual flu shot or PAP screening are 2.4 and 1.8 times more likely to have the HPV vaccine than women who did not receive the shot/screening. The findings of this study can help health care clinicians gain a better understanding of populations not accessing the HPV vaccine. Moreover, since emphasis on prevention is one of most important pillars of U.S. health care reform, this research could assist decision makers in addressing current disparities in cervical cancer prevention.