Using Medical Claims Data to Explore Missed Opportunities for HPV Vaccination Among Adolescents, Ages 11-13, in Iowa

ABSTRACT

Purpose: Despite decades of safety and effectiveness data, human papillomavirus (HPV) vaccination rates remain low, and one-third of adolescents fail to initiate the series by age 13, the age at which it should be completed. While there is extensive research on factors related to uptake, there is less known about the times that eligible adolescents do not get vaccinated (missed opportunities [MOs]). This study sought to quantify the extent of MOs among adolescents ages 11 to 13 during both preventive and acute care visits. Methods: Medical claims data from years 2010 to 2017 from a large midwestern insurance provider were used to calculate total numbers of MOs between ages 11 and 13. Adolescents included had continuous health insurance enrollment born between 2001 and 2004 in Iowa for the three-year period between ages 11 and 13 (n=14,505). The creation of the MO definition was informed by input from primary care and pediatric providers to ensure that all visits that could be potential vaccination opportunities were included. MOs were divided into several categories total, among non-initiators, occurring prior to initiation, occurring after the first dose, and occurring between the first and last dose. Two subgroup comparisons for all categories (urban vs. rural;male vs. female) were explored using t-tests. Results: Overall, less than one-third of adolescents in the sample initiated the series by age 13. Females experienced significantly fewer MOs;5.98 (SD=5.49) for females compared to 6.18 (SD=6.04) for males. For initiators, the majority of MOs occurred prior to initiation of the series, which on average, occurred at age 12;again females experienced significantly fewer MOs compared to males;means for males and females were 3.62 and 4.07, respectively. In sub-group comparisons, rural adolescents tended to have fewer MOs than their urban counterparts and females tended to have fewer MOs than males. For example, urban females had significantly more MOs overall (M=6.08) compared to rural females (M=5.85). Conclusions: Results from this study highlight not only the extent of MOs, but also the utility of medical claims data in understanding patterns of adolescent health care utilization. Claims data provides a comprehensive view and level of granularity not available in other immunization data source. Future research could focus on better understanding the issue of MOs in other geographic areas or among populations with public insurance. Overall, in this sample of privately insured adolescents, it is clear that a lack of opportunity was not a barrier to HPV vaccination, as there were many opportunities in this critical age range, particularly among males and urban adolescents. Additionally, low rates of HPV vaccination have been compounded by the COVID-19 pandemic with many adolescents missing preventive care visits during the pandemic. Moving forward, it will be critical for providers to take advantage of any opportunities to vaccinate, both acute and preventive care visits, to ensure adolescents receive the vaccines they need and reduce these MOs going forward. Sources of Support Cooperative Agreement 3 U48 DP005021-01S4 from the Centers for Disease Control and Prevention and the National Cancer Institute.