The role of access to care and health insurance on HPV vaccination among adults aged 18-45years

Purpose To examine the role of health insurance and access to care on human papillomavirus (HPV) vaccine initiation among adults aged 18-45 years while also comparing results between younger (18-26years) and older adults (27-45years).

Methods The nationally representative dataset, National Health Interview Survey (NHIS), was used to ascertain HPV vaccine initiation among 19, 337 adults. While adjusting for socio-demographic factors, our analysis used regression models to assess the independent effects of health insurance and access to care on HPV vaccine initiation. To examine whether these factors differed between younger and older adults, regression analysis was subcategorized based on age group.

Results Overall, there was an increase in the prevalence of HPV vaccination from 2018 to 2019. Older age, being married, having private health insurance, being uninsured and poor access to care were associated with low vaccine initiation. Among all adults, regardless of year been studied, factors associated with lower odds of vaccination were males, not having health insurance and living in any region except the west. In 2019, the Western region showed higher odds of vaccination compared to the Northeast (West: aOR = 1.12, 95% CI= (0.9,1.39). Also, African Americans and other racial groups were more likely to be vaccinated compared to whites, except for Asians (Asians: aOR = 0.77, 95% CI= (0.6,0.98); African Americans: aOR = 1.13, 95% CI= (0.92,1.38); Others: aOR = 1.29, 95% CI= (0.94,1.75)).

Conclusion Current vaccination efforts targeted at older adults (27-45years) should be encouraged to prevent new HPV infection. Measures to maximize access to care and use of public health insurance should be encouraged. Further research is needed to elucidate on the increase in vaccine initiation among males and in the Western Region.