Introduction: In 2018, the Food and Drug Administration expanded approval age for the HPV vaccine to individuals aged 27-to-45 years old. Investigation of vaccination prevalence and factors association with vaccination in this older age cohort are rare but important given the rise in HPV+ oropharyngeal squamous cell carcinoma. Thus, we sought to explore predictive factors for vaccination among older adults after FDA approval.
Study Design: Cross-sectional
Methods: Cohort included adults aged 30-44 years [TG1] [TG2] from 2018-2022 Behavioral Risk Factor Surveillance System (BRFSS) who completed the HPV vaccination survey module with interview year 2019-2023 (n=26,470). Participants self-reported HPV vaccination status. 3 vaccinations were considered complete vaccination, as all in the cohort were ineligible for initial 2-dose vaccination eligibility upon initial vaccine approval. Prevalence of any HPV vaccination and complete vaccination were analyzed with BRFSS survey weighting. Multivariable regression with survey weighting was utilized to explore predictive factors for HPV vaccination.
Results: On unweighted analysis, the cohort was primarily aged 40-45 years (n=9,476; 35.8%), white (14,580; 56.1%), and female (14,593; 44.7%). The weighted prevalence of any HPV vaccination and full-series vaccination was 15.9% [95%CI:15.2-16.7%] and 6.4% [95%CI:6.0-7.0%], respectively. Upon multivariable regression, relative to those in the 30-34 years age group, those 35-39 years (OR:0.39[95%CI:0.32-0.49]) and 40-44 years (OR:0.17[95%CI:0.13-0.23]) were less likely to receive complete vaccination. Those aged 35-39 years (OR:0.44[95%CI:0.38-0.51]) and 40-45 years (OR:0.23[95%CI:0.19-0.29]) were less likely to have any vaccination. Females were more likely to receive complete (OR:5.17[(95%CI:3.84-6.96]) and any (OR:2.61[95%CI:2.23-3.05]) HPV vaccination than males. Black/African-American (OR:0.75[95%CI:0.56-0.99]), Asian-only (OR:0.48[95%CI:0.31-0.75]), and Hispanic (OR:0.59[95%CI:0.42-0.82]) individuals were less likely to receive complete vaccination compared to white-only individuals. Asian-only (OR:0.64[95%CI:0.46-0.88]) individuals were less likely to receive any HPV vaccine, while mixed race individuals (OR:1.56[95%CI:1.09-2.25]) were more likely. Compared to those in the South, those in the Midwest (OR:2.54[95%CI:1.75-3.69]) and Northeast (OR:1.95[95%CI:1.54-2.47]) were more likely to be completely vaccinated. This was also true for any HPV vaccination, as relative to the South, those in the Midwest (OR:2.34[95%CI:1.85-2.95]) and Northeast (OR:1.88[95%CI:1.60-2.20]) were more likely to receive any HPV vaccine. High school graduates (OR:2.21[95%CI:1.75-3.69]), those with some college (OR:2.62[95%CI:1.28-5.39]]), and college graduates (OR:4.75[95%CI:2.30-9.79]) were more likely to be completely vaccinated than those with only some high school education. Compared to those with some high school education, those with some college education (OR:1.53[95%CI:1.01-2.33]) and college graduates (OR:2.27[95%CI:1.49-3.46]) were more likely to have any HPV vaccine, though high school graduates (OR:1.29[95%CI:0.84-1.97]) were not more likely. Compared to those who are married, those previously but not currently married (OR:1.65[95%CI:1.18-2.29] and OR:1.76[95%CI:1.41-2.19]), those who have never been married (OR:1.56[95%CI:1.19-2.04] and OR:1.58[95%CI:1.31-1.90]), and those in unmarried partnerships (OR:1.80[95%CI:1.26-2.54] and OR:1.40[95%CI:1.06-1.83]) were more likely to have complete or any HPV vaccination, respectfully. Additionally, those with a personal doctor were more likely to receive full vaccine series (OR:1.79[95%CI:1.24-2.60]) and any vaccine (OR:1.29[95%CI:1.03-1.61]). Those with any cancer history (OR:1.15[95%CI:0.75-1.75]) or history of head and neck cancer (OR:1.11[95%CI:0.21-5.81]) did not have increased likelihood of complete vaccination or any HPV vaccination (OR:1.29[95%CI:0.94-1.76] and OR:0.40[95%CI:0.08-2.09], respectively.
Conclusions: This study demonstrates low overall HPV vaccination in US Adults aged 27-45 years. While much of this is explained by personal situation, such as marital status, this study reveals that educational and access issues continue to significantly affect vaccination status in this cohort.