Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network

Julie H T Dang; Susan L Stewart; Dean A Blumberg; Hector P Rodriguez; Moon S Chen Jr

doi:10.1016/j.vaccine.2021.04.055

Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network

Vaccine. 2021 Jun 11;39(26):3528-3535. doi: 10.1016/j.vaccine.2021.04.055. Epub 2021 May 19.

Authors

Julie H T Dang¹, Susan L Stewart², Dean A Blumberg³, Hector P Rodriguez⁴, Moon S Chen Jr⁵

Affiliations

¹ University of California, Davis School of Medicine, Division of Health Policy and Management, Department of Public Health Sciences, 4501 X Street, Suite 3003, Sacramento, CA 95817, USA. Electronic address: jtdang@ucdavis.edu.
² University of California, Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, 2450 48th Street, Suite 1600, Sacramento, CA 95817, USA.
³ University of California, Davis Health, Department of Pediatrics, 2561 Stockton Blvd, Sacramento, CA 95817, USA.
⁴ University of California, Berkeley, School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way #5427, Berkeley, CA 94704, USA.
⁵ University of California, Davis School of Medicine, Division of Hematology and Oncology, 2540 48th Street, Suite 1600, Sacramento, CA 95817, USA.

PMID: 34023133
DOI: 10.1016/j.vaccine.2021.04.055

Abstract

Background: Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11-17, of a large community-based primary care network.

Methods: Electronic health records and administrative data from a large primary care network from January 2017 - June 2018 for patients ages 11-17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake.

Results: Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1-3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6-2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 - 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3-0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7-0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 - 1.0).

Conclusion: HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.

Keywords: Adolescent; Clinician; Human Papillomavirus; Primary Care; Vaccine Uptake.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Alphapapillomavirus*
Child
Female
Humans
Male
Papillomavirus Infections* / prevention & control
Papillomavirus Vaccines*
Primary Health Care
Vaccination

Substances

Papillomavirus Vaccines

Grants and funding

P30 CA093373/CA/NCI NIH HHS/United States