Better, worse, or holding the course? Analysis of HPV vaccination patterns in the US, 2008-2020

This analysis aims to understand temporal HPV vaccination coverage patterns by Health and Human Services Region (hereafter, Region) and state from 2008 to 2020.

We analyzed National Immunization Survey-Teen data (2008-2020), assessing 6 measures addressing initiation and up-to-date status by sex, as available over time. We compared, annually, Regional coverage to the national average and state-level coverage to the Regional average, identifying states and Regions as positive or negative deviants for each measure if coverage estimates diverged by at least 5 percentage points in either direction.

Regions 1 and 9 were positive deviants and Regions 4 and 6 were negative deviants. Within deviant Regions, there were positive and negative deviant states identified, including positive deviant states within negative deviant regions (e.g. North Carolina in Region 4) and the inverse (e.g. Connecticut in Region 1).

Through this novel visualization of national, Regional, and state-level HPV vaccine uptake, we unmasked patterns to support future evaluations and interventions. Future work should focus on identification and assessment of factors leading to success and opportunities for improvement for HPV vaccine promotion efforts.