‘Concerning’ disparities in HPV vaccine uptake among US adults, with men and Hispanic people among those least protected

An analysis of data from a nationwide health survey reveals “concerning” disparities in human papillomavirus (HPV) vaccine uptake among US adults aged 27 to 45 years.

More than 84% of the 9,440 people involved in a national sample had yet to be vaccinated for this common virus, which can cause cancers later in life, such as cervical, oropharyngeal (throat), anal, penile, vaginal and vulvar.

Low uptake in the vaccine was observed among men, as well as people of Hispanic heritage, and those with lower educational levels.

Publishing their findings in Human Vaccines & Immunotherapeutics, the expert team states the results highlight an “urgent need” to address and mitigate disparities in HPV vaccine uptake in this age group and raise awareness of the importance of the vaccine—especially for men, who were more than three times less likely to be vaccinated.

“The overall low uptake of the HPV vaccine in this age group, raises concerns regarding cancer prevention efforts,” states lead author Dr. Nosayaba Osazuwa-Peters, who is a head and neck cancer epidemiologist at Duke University School of Medicine’s and the Duke Cancer Institute, in North Carolina.

“Given the importance of the HPV vaccine in cancer prevention, it is critical that these disparities are addressed and mitigated. Addressing disparities and improving access to vaccination services are crucial steps in preventing HPV-associated cancers and improving public health outcomes for all.

“Males are in particular need of increased knowledge of the vaccine, in light of the increasing incidence of both anal and oropharyngeal cancers, which are known to originate from the HPV virus. When the HPV vaccine was first approved in the US in 2006, it was approved for only girls, and with a focus on cervical cancer; so, males have literally been playing catch-up the whole time. Interestingly, as of now, oropharyngeal cancer[s], 75% of which are in males, have overtaken cervical cancer, for which the vaccine was originally developed.”

With nearly 36,000 people diagnosed with an HPV-associated cancer each year in the US, HPV vaccination offers a critical opportunity for cancer prevention, potentially preventing more than 90% of these cancers.

While routine HPV vaccination was initially recommended for children aged 11 to 12 years, with catch-up vaccination through to age 26 years, the US Food and Drug Administration (FDA) expanded the age range for eligibility to adults aged 27 to 45 years in 2018. However, there is little currently known about the uptake of the vaccine within this age group.

This research analyzed data from the 2019 National Health Interview Survey, which collects cross-sectional health data from a nationally representative sample of the US population. It is the first study since the FDA age expansion to exclusively examine differential HPV vaccine uptake in a diverse sample of 27- to 45-year-old adults from across the US population.

Results reveal that a significant proportion (84.5%) of participants had not yet been vaccinated against HPV.

The outcomes also unveil disparities in HPV vaccine uptake based on demographic and socioeconomic factors:

• Females had over three times greater odds of vaccine uptake compared to males.
• Non-Hispanic Blacks were 36% more likely, while Hispanics were 27% less likely, to receive the vaccine compared to non-Hispanic whites.
• Individuals without a usual place of care and those with lower educational levels had lower odds of vaccine uptake.

Dr. Osazuwa-Peters, who led a team of specialists from institutions across the US, adds, “For oropharyngeal cancer, about 75% of new cases are in males. As oral HPV is the primary cause of HPV-associated oropharyngeal cancer, providing the HPV vaccine to middle-aged individuals is undoubtedly an important strategy to decreasing risk of infection, persistence, and eventual HPV-associated oropharyngeal malignancy.

“While the population benefit of the HPV vaccines in preventing oropharyngeal cancer may not be realized until years later, there are ongoing clinical trials to definitely establish that the current vaccines are effective in the prevention of oral HPV infection.”

Of particular concern, too, is the lower likelihood of HPV vaccine uptake among Hispanic adults, they authors add, emphasizing the need for targeted interventions to increase awareness and access to vaccination.

Overall, the expert team state their findings should “serve as a call to action for policymakers, health care providers, and community leaders to intensify efforts to promote HPV vaccination among adults aged 27 to 45 years.”

A key strength of this study lies in its analysis of a nationally representative sample of data. However, its limitations include a reliance on self-reported data and the inability to determine the exact age of HPV vaccination among participants.