Insurance continuity and human papillomavirus vaccine uptake in Oregon and California federally qualified health centers

S. Cowburn, M. Carlson, J. Lapidus, J. Heintzman, S. Bailey and J. DeVoe

American Journal of Public Health, 2014, vol. 104, issue 9, e71-e79

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.

Keywords: Wart virus vaccine, adolescent; adult; age; article; child; electronic medical record; ethnology; female; health insurance; human; insurance; patient attitude; retrospective study; safety net hospital; socioeconomics; statistics; United States; young adult, Adolescent; Adult; Age Factors; California; Child; Electronic Health Records; Female; Humans; Insurance Coverage; Insurance, Health; Oregon; Papillomavirus Vaccines; Patient Acceptance of Health Care; Retrospective Studies; Safety-net Providers; Socioeconomic Factors; Young Adult (search for similar items in EconPapers)
Date: 2014
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2014.302007_1

DOI: 10.2105/AJPH.2014.302007

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