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SGO 2019: HPV Vaccine Uptake in the Deep South

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Key Points

  • Data showed little difference in HPV vaccine uptake between metropolitan and rural areas (44.5% vs 45.9%, P = .91) or between affluent and impoverished counties (42.9% vs 46.9%, P = .75).
  • The seven counties with the highest HPV vaccine uptake, in fact, were all rural areas with above average poverty rates.
  • The study also found a strong link between higher HPV vaccine uptake among residents receiving government-funded health care, and found that the highest HPV vaccine rates were in some of the 23 counties without a single pediatrician.

A study by Pierce et al presented at the Society of Gynecologic Oncology’s (SGO) 50th Annual Meeting on Women’s Cancer showed that human papillomavirus (HPV) vaccination rates in Alabama are highest in counties with high incidence rates of HPV-related cancer (Abstract 13).  

“The higher the rate of cancer in the county, the higher the rate of vaccination,” said presenter Jennifer Young Pierce, MD, MPH, of the USA Health Mitchell Cancer Institute, in a statement.

The study aimed to discover reasons behind the wide variance of HPV vaccination rates throughout Alabama, where cervical cancer incidence is higher than the national rate and county vaccination rates range from 33% to 66%.

“It’s really impossible to generalize across the state that we are or are not doing well,” said Dr. Pierce. “We drilled down the data to the county level to see what’s associated with this.”

Study Findings

Of Alabama’s 67 counties, 32 are considered rural, and 40 have poverty levels below the state average. The study’s authors expected to see lower HPV vaccine uptake in Alabama’s rural counties, which would be consistent with Centers for Disease Control and Prevention reports. Instead, the data showed little difference in HPV vaccine uptake between metropolitan and rural areas (44.5% vs 45.9%, P = .91) or between affluent and impoverished counties (42.9% vs 46.9%, P = .75). The seven counties with the highest HPV vaccine uptake, in fact, were all rural areas with above average poverty rates.

“It was exactly the opposite of what we expected,” said Dr. Pierce. “In the rest of the country, there’s an urban/rural disparity, an 11-point difference between rural and urban vaccine uptake, and we do not see that in Alabama. If you take all the rural counties and all the urban counties, it’s more even.”

The study yielded other results: a strong link between higher HPV vaccine uptake among residents receiving government-funded health care, and the highest HPV vaccine rates in some of the 23 counties without a single pediatrician.

The main takeaway from the study, concluded Dr. Pierce, is that perception of high cancer risk overcomes traditional disparities (income level, location, type of health insurance) that can affect HPV vaccine uptake.

Disclosure: The study authors' full disclosures can be found at sgo.confex.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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