title: Human papillomavirus vaccine uptake among individuals with systemic inflammatory diseases.
abstract: OBJECTIVE
  The human papillomavirus (HPV) vaccine is safe and efficacious in patients with systemic inflammatory diseases (SID) who have higher rates of persistent HPV infection. We compared HPV vaccine uptake among SID and non-SID patients.
  
  
  METHODS
  Using a U.S. insurance claims database (2006-2012), we identified individuals 9-26 years with ≥2 SID diagnosis codes ≥7 days apart with ≥12 months of continuous enrollment prior to the second code (index date). We matched SID patients by age, sex and index date to randomly selected non-SID subjects and selected those with ≥24 months of post-index date continuous follow-up. We also identified a non-SID subcohort with ≥1 diagnosis code for asthma. We defined initiation as ≥1 HPV vaccination claim after 2007, and completion as 3 claims. We used multivariable logistic regression to assess uptake in females 11-26 years comparing SID, non-SID and asthma cohorts, adjusting for demographics, region, comorbidities, and healthcare utilization.
  
  
  RESULTS
  We identified 5,642 patients 9-26 years with SID and 20,643 without. The mean age was 18.1 years (SD 4.9). We identified 1,083 patients with asthma; the mean age was 17.2 (SD 5.1). Among females, 20.6% with SID, 23.1% without SID and 22.9% with asthma, received ≥1 HPV vaccine. In our adjusted models, the odds of receipt of ≥1 vaccine was 0.87 times lower in SID (95% CI 0.77-0.98) compared to non-SID and did not differ for 3 vaccines (OR 1.03, 95% CI 0.83-1.26). The odds of initiation and completion were not statistically different between SID and non-SID asthma cohorts.
  
  
  CONCLUSIONS
  In this nationwide cohort, HPV vaccine uptake was extremely low. Despite the heightened risk of persistent HPV infection among those with SID, no increase in HPV vaccine uptake was observed. Public health efforts to promote HPV vaccination overall are needed, and may be particularly beneficial for those at higher risk.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Candace H
authors.initials: CH
authors.lastname: Feldman
authors.affiliation: Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Linda T
authors.initials: LT
authors.lastname: Hiraki
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Huichuan
authors.initials: H
authors.lastname: Lii
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: John D
authors.initials: JD
authors.lastname: Seeger
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000821:virology; D008297:Male; D053918:Papillomavirus Vaccines; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012306:Risk; D012737:Sex Factors; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines