The Affordable Care Act and change in human papillomavirus (HPV) vaccine uptake in the United States.

BACKGROUND: Human papillomavirus (HPV) vaccination uptake has increased in the United States yet continues to fall short of the Healthy People 2030 goal. Cost of care is a known barrier. The Affordable Care Act (ACA) aimed to enhance access to preventive healthcare services, including HPV vaccination. Our study examined the association between the ACA and known vaccination-enabling factors in the United States. METHODS: We analyzed data from 29,216 adults aged 18-26 in the National Health Interview Survey from 2011 to 2017. Changes in vaccination-enabling factors (regular physician visitation and changes in health insurance status) and HPV vaccination status pre- (2011-2013; n = 13,494) to post-ACA (2014-2017; n = 15,722) were assessed using logistic regression models adjusted for poverty, education, marital status, comorbidities, sex, and geography. RESULTS: A total of 13,494 and 15,722 eligible individuals were identified pre- and post-ACA, respectively. Post-ACA, the proportion of individuals reporting receipt of one dose of the HPV vaccine increased by 43 % (3.9 % to 5.5 %; OR 1.45, 95 % CI 1.24, 1.70; p < .001), with significant gains among non-Hispanic White (OR 1.55, 95 % CI 1.24, 1.94) and Black individuals (OR 1.59, 95 % CI 1.12, 2.29). Completion of ≥2 doses rose from 12.5 % to 17.8 % (OR 1.62, 95 % CI 1.47, 1.79), notably among Hispanic individuals (7.6 % to 14.7 %, ORinteraction = 1.36, 95 % CI 1.05, 1.77; p = .020). Post-ACA, there was a significant decrease in uninsured rates and an increase in vaccination completion odds among individuals privately insured (OR 1.36, 95 % CI 1.22, 1.52; p < .001) and those insured by Medicaid (OR 1.81, 95 % CI 1.35, 2.43; p < .001). Regular physician visits also rose pre- to post-ACA (53.1 % to 57.1 %, OR 1.17, 95 % CI 1.09, 1.25; p < .001). CONCLUSION: The ACA has been associated with increased HPV vaccination uptake, especially among racial/ethnic minorities, gains likely driven by an increase in vaccination-enabling factors such as decreased uninsurance and increased access to physician visits.

Duke Scholars

Author Nosayaba Osazuwa-Peters Head & Neck Surgical Oncology