Initiation and completion rates for the human papillomavirus vaccine series are significantly lower in the South than in any other geographic region, according to a study of 12 states.
University of Texas Medical Branch at Galveston researchers, who conducted the study, said the new findings especially are disconcerting because cervical cancer which is caused almost exclusively by HPV is more prevalent in the South than in any other region.
And although vaccination rates have risen since 2008, the findings underscore the need for increased clinician recommendation and vaccine assistance programs.
The study, published in the November issue of the journal Vaccine, examined the association between geographic region and HPV vaccine uptake and completion rates among 2,632 women ages 18 to 26 in 12 states. The study is described as the first of its kind to include initiation and completion rates and assess data across multiple years.
The researchers used data collected between 2008 and 2010 from the Behavioral Risk Factor Surveillance System, the worlds largest ongoing health survey, from 12 states representing four distinct regions: the Northeast (Connecticut, Massachusetts, Pennsylvania, Rhode Island); the Midwest (Kansas, Minnesota, Nebraska); the West (Wyoming); and the South (Delaware, Oklahoma, Texas, West Virginia).
The researchers found that nationwide, an average of 28% of women reported initiating the vaccine and 17% reported completing the three-dose series over the three-year period.
When examined by region over the three-year period, HPV vaccine initiation and completion rates were 37.2% and 23.1%, respectively, in the Northeast; 28.7% and 19.3% in the Midwest/West; and 14% and 6% in the South.
The initiation rate rose from 20.8% in 2008 to 44.1% in 2010 in the Northeast. It dropped from 36.4% to 29.2% during that span in the Midwest, and rose from 14% to 22.5% in the South.
Adjusted for age, race/ethnicity, marital status, education, income, health coverage and routine medical check-ups/flu vaccines, women living in the South remained less likely to initiate or complete the HPV vaccine series.
White women were more likely to initiate and complete the vaccine series compared with other races and ethnicities, the researchers reported.
If a lower rate of HPV vaccine uptake in the South persists, it could contribute to the national burden of cervical cancer in the long run, study author Abbey Berenson, MD, professor in the department of obstetrics and gynecology and director of UTMBs Center for Interdisciplinary Research in Womens Health, said in a news release.
We need more physician referrals, public financing for vaccine programs and educational interventions to improve HPV vaccine uptake if we want to lower rates of HPV-related diseases.
An estimated 79 million Americans are infected with HPV, according to the news release, and most sexually active persons will contract at least one type of HPV at some point in their lives. The virus is responsible for nearly all cases of cervical cancer, which each year kills more than 4,000 American women, half of whom are estimated to live in the South. HPV also is associated with genital warts and vulvar, vaginal, penile, anal and oropharyngeal cancers.
The researchers believe regional disparities could arise from a confluence of several factors, including differences in income, education and insurance coverage. We need to examine whether regional or state-level policies contribute to these variations, especially if these policies are hindering patients from learning about or receiving the vaccine, lead study author Mahbubur Rahman, PhD, MPH, MBBS, associate professor of obstetrics and gynecology at UTMB, said in the news release.
Study abstract: http://www.sciencedirect.com/science/article/pii/S0264410X1301253X