title: Disparities in human papillomavirus vaccine completion among vaccine initiators.
abstract: OBJECTIVE
  To estimate rates of completing the full three-dose prophylactic human papillomavirus (HPV) vaccination regimen in patients who initiated the series and to identify variables associated with not completing vaccination.
  
  
  METHODS
  This single-institution review identified all patients initiating HPV vaccination at one of four affiliated clinics between January 2007 and June 2008. Vaccination "completers" were defined as patients who had completed all three vaccinations within 12 months of initiating the vaccination series. Logistic regression was used to identify factors associated with vaccine completion. Variables analyzed included age, type of insurance (private compared with public), practice location (urban compared with suburban), practice type (pediatrics, gynecology, or family practice), and race or ethnicity (white or African American and Hispanic).
  
  
  RESULTS
  Of the 1,413 girls and young women who initiated HPV vaccination, 469 (33.2%) completed the vaccine series. Overall, private insurances (odds ratio 1.87, 95% confidence interval 1.26-2.76) and suburban practice locations (odds ratio 1.44, 95% confidence interval 1.04-1.98) were associated with higher vaccine completion rates. African American race was associated with lower completion rates (odds ratio 0.50, 95% confidence interval 0.38-0.65). In multivariable analyses, the combination of younger age (11-17 years) and urban practice location was associated with very low likelihood of completing HPV vaccination (22%; P=.023).
  
  
  CONCLUSIONS
  The HPV vaccine completion rate is low. When resources are limited, disparities in HPV vaccine completion should be considered when developing programs to improve vaccine utilization. Urban girls and young women should be targeted as an at-risk population.
authors.affiliation: From the Departments of Gynecology and Obstetrics, Oncology, and Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; the Department of Obstetrics and Gynecology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; and the Department of Mathematics, Stevenson University, Stevenson, Maryland.
authors.forename: Betty
authors.initials: B
authors.lastname: Chou
authors.forename: Lauren S
authors.initials: LS
authors.lastname: Krill
authors.forename: Bernice B
authors.initials: BB
authors.lastname: Horton
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Barat
authors.forename: Cornelia L
authors.initials: CL
authors.lastname: Trimble
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines