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Disparities in Human Papillomavirus Vaccine Completion Rates Among Females in an Integrated Health Care System

Freeman, Alexandra (Jana) H., MD; Gamboa, Cristina, MD; Darbinian, Jeanne A., MS, MPH; Littell, Ramey D., MD; Torrente, Sandra, MD

doi: 10.1097/AOG.0000000000002802
Contents: Original Research

OBJECTIVE: To estimate the rate of human papillomavirus (HPV) vaccine completion by race and ethnicity.

METHODS: In this retrospective cohort study, we analyzed females aged 11–26 years who initiated HPV vaccination from 2008 through 2012 in a community-based health care system in California. Vaccine completion was defined as having received at least three injections. Demographic data including age, race, ethnicity, and language preferences were obtained. Among Hispanic patients, acculturation was categorized as low or high using written and spoken Spanish vs English language as a proxy. Age groups were defined as younger adolescents (11–14 years), teens (15–17 years), and young adults (18–26 years). Bivariate analyses using χ2 tests and age-adjusted logistic regression were performed.

RESULTS: Among 102,052 females who initiated HPV vaccination, a total of 41,847 (41%) completed the series. Younger adolescents had the highest completion rates (43.4%, P<.001) vs teens and young adults (37.4% and 38.0%, respectively). By race and ethnicity, Asian patients had the highest completion rates (49.5%, 95% CI 48.8–50.2), and the lowest rates were seen among black and Hispanic patients (28.7% [95% CI 27.8–29.6] and 38.9% [95% CI 38.3–39.5], respectively). Among Hispanic patients, the adjusted odds for vaccine completion was 1.2-fold higher for the low acculturated vs the highly acculturated group (adjusted odds ratio 1.23 [95% CI 1.16–1.31]).

CONCLUSION: More than half of the females who initiated HPV vaccination did not complete the series, and black and Hispanic patients were least likely to have completed the series. Among Hispanic patients, the highest acculturated group had the lowest completion rate. These disparities emphasize the need for cancer prevention across all racial and ethnic groups.

Among a diverse group of insured females, low rates of human papillomavirus vaccination series completion were demonstrated; these rates varied by race and ethnicity.

Kaiser Permanente Northern California Gynecologic Cancer Program, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, Salud Para La Gente, Watsonville, Kaiser Permanente Northern California, Division of Research, Oakland, and Kaiser Permanente San Francisco Medical Center, San Francisco, California.

Corresponding author: Alexandra (Jana) H. Freeman, MD, Helen Diller Family Comprehensive Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 7th Floor, San Francisco, CA 94143; email:

Financial support of this article was provided by Kaiser Permanente Northern California Graduate Medical Education Program, Kaiser Foundation Hospitals.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Western Association of Gynecologic Oncologists’ annual meeting, June 14–17, 2017, Rancho Mirage, California.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received March 15, 2018

Received in revised form June 01, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.