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Published on: May 6, 2015
Small area estimation of human papillomavirus vaccination coverage among school-age children in Alabama counties
D L Albright1, H Y Lee2, J T McDaniel3
1Hill Crest Foundation Endowed Chair of Mental Health, School of Social Work, The University of Alabama, Box 870314, Tuscaloosa, AL, 35487-0314, USA.
Objectives:
This study estimated county-level human papillomavirus (HPV) vaccination initiation rates in Alabama and determined whether disparities existed between counties in the Mississippi Delta region (MDR) and Appalachian region (AR).
Study Design:
This study used an observational cross-sectional design.
Methods:
We used small area estimation methodology to estimate rates of medical provider-verified HPV vaccine initiation among school-age children in Alabama. Data for the study were retrieved from the 2015 National Immunization Survey (n = 22,205) and the US Census Bureau.
Results:
The predictive model results showed that older age (odds ratio [OR] = 1.22, 95% confidence interval [CI] = 1.16, 1.29) was positively associated with vaccination initiation and black (OR = 0.79, 95% CI = 0.71, 0.87), white (OR = 0.56, 95% CI = 0.52, 0.60), and 'other' race/ethnicities (OR = 0.78, 95% CI = 0.70, 0.86), compared with Hispanics, and was negatively associated with vaccination initiation. The median (x̃)-modeled HPV vaccination initiation rate for all Alabama counties was 50.83% (interquartile range = 5.00%). Modeled HPV vaccination initiation rates were lowest in AR counties (x̃ = 49.81%), followed by counties not in the AR or MDR (x̃ = 53.26%) and MDR counties (x̃ = 54.90%).
Conclusions:
Culturally sensitive school-based HPV vaccine delivery programs are needed for children living in AR counties in Alabama.
