Stuart Cowburn1, Matthew Carlson, Jodi Lapidus, John Heintzman, Steffani Bailey, Jennifer DeVoe. 1. Stuart Cowburn is with OCHIN, Inc., Portland, OR. Matthew Carlson is with the Department of Sociology, Portland State University, Portland. Jodi Lapidus is with the Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. John Heintzman, Steffani Bailey, and Jennifer DeVoe are with the Department of Family Medicine, Oregon Health & Science University, Portland.
Abstract
OBJECTIVES: We examined the association between insurance continuity and human papillomavirus (HPV) vaccine uptake in a network of federally qualified health clinics (FQHCs). METHODS: We analyzed retrospective electronic health record data for females, aged 9-26 years in 2008 through 2010. Based on electronic health record insurance coverage information, patients were categorized by percent of time insured during the study period (0%, 1%-32%, 33%-65%, 66%-99%, or 100%). We used bilevel multivariable Poisson regression to compare vaccine-initiation prevalence between insurance groups, stratified by race/ethnicity and age. We also examined vaccine series completion among initiators who had at least 12 months to complete all 3 doses. RESULTS: Significant interactions were observed between insurance category, age, and race/ethnicity. Juxtaposed with their continuously insured peers, patients were less likely to initiate the HPV vaccine if they were insured for less than 66% of the study period, aged 13 years or older, and identified as a racial/ethnic minority. Insurance coverage was not associated with vaccine series completion. CONCLUSIONS: Disparities in vaccine uptake by insurance status were present in the FQHCs studied here, despite the fact that HPV vaccines are available to many patients regardless of ability to pay.
OBJECTIVES: We examined the association between insurance continuity and human papillomavirus (HPV) vaccine uptake in a network of federally qualified health clinics (FQHCs). METHODS: We analyzed retrospective electronic health record data for females, aged 9-26 years in 2008 through 2010. Based on electronic health record insurance coverage information, patients were categorized by percent of time insured during the study period (0%, 1%-32%, 33%-65%, 66%-99%, or 100%). We used bilevel multivariable Poisson regression to compare vaccine-initiation prevalence between insurance groups, stratified by race/ethnicity and age. We also examined vaccine series completion among initiators who had at least 12 months to complete all 3 doses. RESULTS: Significant interactions were observed between insurance category, age, and race/ethnicity. Juxtaposed with their continuously insured peers, patients were less likely to initiate the HPV vaccine if they were insured for less than 66% of the study period, aged 13 years or older, and identified as a racial/ethnic minority. Insurance coverage was not associated with vaccine series completion. CONCLUSIONS: Disparities in vaccine uptake by insurance status were present in the FQHCs studied here, despite the fact that HPV vaccines are available to many patients regardless of ability to pay.
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