title: A Population-Based Study of Sociodemographic and Geographic Variation in HPV Vaccination.
abstract: Background:Human papillomavirus (HPV) vaccination rates in the United States remain low and lag behind other recommended adolescent vaccines. Studies evaluating the association of geographic and area-level characteristics with HPV vaccination rates provide a valuable resource for public health planning.Method:We used the Rochester Epidemiology Project data linkage system to ascertain HPV vaccination rates between 2010 and 2015 in a 7-county region of southern Minnesota. Geocoded individual patient data were spatially linked to socioeconomic data from the American Community Survey at the census block group level. Bayesian hierarchical logistic regression was used to model incident vaccination rates, adjusting for individual- and area-level sociodemographic characteristics, and geolocation. Geolocation was modeled as an approximated Gaussian field using a Stochastic Partial Differential Equations approach. All models were estimated using Integrated Nested Laplace Approximations.Results:In adjusted models, increasing age and female sex were associated with increased HPV vaccination. Lower socioeconomic status was associated with decreased rates of initiation [adjusted odds ratio (AOR); 95% confidence interval = 0.90 (0.86-0.95)], completion of the second dose [AOR = 0.88 (0.83-0.93)], and completion of the third dose [AOR = 0.85 (0.80-0.92)]. Geographic spatial analysis demonstrated increased odds of vaccination for the eastern region and in the greater Rochester metropolitan area, showing significant spatial variation not explained by individual level characteristics and ACS block group-level data.Conclusions:HPV vaccination rates varied geographically and by individual and geographically indexed sociodemographic characteristics.Impact:Identifying geographic regions with low HPV vaccination rates can help target clinical and community efforts to improve vaccination rates.Cancer Epidemiol Biomarkers Prev; 26(4); 533-40. ©2017 AACRSee all the articles in thisCEBP Focussection, "Geospatial Approaches to Cancer Control and Population Sciences."
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. Rutten.lila@mayo.edu.|Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lila J
authors.initials: LJ
authors.lastname: Finney Rutten
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.|Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Wilson
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.|Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.|Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Amenah A
authors.initials: AA
authors.lastname: Agunwamba
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Carmen
authors.initials: C
authors.lastname: Radecki Breitkopf
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.|Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Jacobson
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.|Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
mesh_terms: D000293:Adolescent; D000367:Age Factors; D040343:Behavioral Risk Factor Surveillance System; D002648:Child; D003710:Demography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008910:Minnesota; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012737:Sex Factors; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines