Identifying Measures for Understanding and Addressing County-Level Disparities in Adolescent HPV Vaccination Coverage...

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Geographic disparities in human papillomavirus (HPV) vaccination coverage exist in the US, with lower rates in rural areas.
• Understanding how different rurality measures characterize these disparities is crucial for targeted quality improvement efforts.

Purpose of the Study:

• To assess the association between various county-level rurality measures and HPV vaccination coverage in North Carolina.
• To identify which factors best explain geographic disparities in HPV vaccination rates within the state.

Main Methods:

• Negative binomial regression models analyzed associations between five rurality measures and HPV vaccination coverage (≥1 dose) in North Carolina adolescents (n=326,345).
• Rurality measures included OMB Metropolitan Statistical Areas, Rural-Urban Continuum Codes, Index of Relative Rurality, US Census Bureau, and NC Rural Center classifications.
• Models controlled for Social Vulnerability Index (SVI) and pediatrician density, using data from the NC Immunization Registry.

Main Results:

• Overall HPV vaccination coverage was 29% across North Carolina counties.
• None of the five rurality measures showed a significant correlation with HPV vaccination coverage after adjustment.
• Higher Social Vulnerability Index (SVI) and greater pediatrician density were positively associated with higher vaccination coverage (P < 0.01).

Conclusions:

• County-level rurality measures, as defined in this study, did not effectively identify disparities in HPV vaccination coverage in North Carolina.
• Social vulnerability and pediatrician access appear to be more pertinent factors for understanding and addressing vaccination coverage gaps at the county level.