title: Insurance continuity and human papillomavirus vaccine uptake in Oregon and California federally qualified health centers.
abstract: OBJECTIVE
  We examined the association between insurance continuity and human papillomavirus (HPV) vaccine uptake in a network of federally qualified health clinics (FQHCs).
  
  
  METHODS
  We analyzed retrospective electronic health record data for females, aged 9-26 years in 2008 through 2010. Based on electronic health record insurance coverage information, patients were categorized by percent of time insured during the study period (0%, 1%-32%, 33%-65%, 66%-99%, or 100%). We used bilevel multivariable Poisson regression to compare vaccine-initiation prevalence between insurance groups, stratified by race/ethnicity and age. We also examined vaccine series completion among initiators who had at least 12 months to complete all 3 doses.
  
  
  RESULTS
  Significant interactions were observed between insurance category, age, and race/ethnicity. Juxtaposed with their continuously insured peers, patients were less likely to initiate the HPV vaccine if they were insured for less than 66% of the study period, aged 13 years or older, and identified as a racial/ethnic minority. Insurance coverage was not associated with vaccine series completion.
  
  
  CONCLUSIONS
  Disparities in vaccine uptake by insurance status were present in the FQHCs studied here, despite the fact that HPV vaccines are available to many patients regardless of ability to pay.
authors.affiliation: Stuart Cowburn is with OCHIN, Inc., Portland, OR. Matthew Carlson is with the Department of Sociology, Portland State University, Portland. Jodi Lapidus is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. John Heintzman, Steffani Bailey, and Jennifer DeVoe are with the Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Stuart
authors.initials: S
authors.lastname: Cowburn
authors.forename: Matthew
authors.initials: M
authors.lastname: Carlson
authors.forename: Jodi
authors.initials: J
authors.lastname: Lapidus
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.forename: Steffani
authors.initials: S
authors.lastname: Bailey
authors.forename: Jennifer
authors.initials: J
authors.lastname: DeVoe
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002140:California; D002648:Child; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D009922:Oregon; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines