title: Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital.
abstract: BACKGROUND
  Despite the benefit of the human papillomavirus (HPV) vaccine in preventing cervical cancer, fewer than half of eligible young women in the United States have initiated the three-vaccine series. Among those who initiate HPV vaccination, large proportions do not complete the three-dose regimen.
  
  
  OBJECTIVE
  To evaluate racial and health insurance-related disparities in HPV vaccination.
  
  
  METHODS
  We analyzed outpatient claims data for 8069 patients, ages 9-26 years, who had gynecologic visits at the University of Maryland Medical Center outpatient clinic from August 2006 to January 2010.
  
  
  RESULTS
  Thirty-five percent of our sample initiated the vaccine series, including 91% of those ages 9-13. Only 11% of the sample and 33% of the 9-13 age group completed the 3 dose series. A higher proportion of blacks than whites (38% vs. 32%; p<0.01) initiated, and 11% and 12%, respectively, of each race completed. Lower age was strongly correlated with uptake. After adjustment for insurance, blacks were less than half as likely as whites to complete the series in all age groups, and had 0.35 the odds (95% CI 0.26-0.46) of adherence. The uninsured had much lower race-adjusted odds than insured groups for initiation, but had similar adherence rates. Publicly insured individuals were more likely than the privately insured to complete all 3 doses.
  
  
  CONCLUSIONS
  Of the population of gynecologic service seekers seen at our university-based outpatient practice clinics, a significant minority initiate but do not complete the HPV vaccine series. More blacks than whites initiate the series, but similar proportions of the two races complete. Lack of insurance appears to be a major barrier to initiation, despite free vaccination programs.
authors: University of Maryland, School of Medicine, Department of Epidemiology and Public Health, 10 South Pine Street, MSTF 334F, Baltimore, MD 21201, United States.
authors: Nicholas H
authors: NH
authors: Schluterman
authors: Mishka
authors: M
authors: Terplan
authors: Alison D
authors: AD
authors: Lydecker
authors: J Kathleen
authors: JK
authors: Tracy
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001294:Attitude to Health / Q000208:ethnology; D002648:Child; D005260:Female; D054625:Healthcare Disparities; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D015999:Multivariate Analysis; D016017:Odds Ratio; D010045:Outpatients; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines