Geographic poverty and racial/ethnic disparities in cervical cancer precursor rates in Connecticut, 2008-2009.

OBJECTIVES: We examined associations of geographic measures of poverty, race, ethnicity, and city status with rates of cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ (CIN2+/AIS), known precursors to cervical cancer. METHODS: We identified 3937 cases of CIN2+/AIS among women aged 20 to 39 years in statewide surveillance data from Connecticut for 2008 to 2009. We geocoded cases to census tracts and used census data to calculate overall and age-specific rates. Poisson regression determined whether rates differed by geographic measures. RESULTS: The average annual rate of CIN2+/AIS was 417.6 per 100,000 women. Overall, higher rates of CIN2+/AIS were associated with higher levels of poverty and higher proportions of Black residents. Poverty was the strongest and most consistently associated measure. However, among women aged 20 to 24 years, we observed inverse associations between poverty and CIN2+/AIS rates. CONCLUSIONS: Disparities in cervical cancer precursors exist for poverty and race, but these effects are age dependent. This information is necessary to monitor human papillomavirus vaccine impact and target vaccination strategies.

Human papillomavirus vaccination history among women with precancerous cervical lesions: disparities and barriers.

OBJECTIVE: To estimate racial, ethnic, and socioeconomic differences in human papillomavirus (HPV) vaccination history among women aged 18-27 years with precancerous cervical lesions diagnosed, barriers to vaccination, and timing of vaccination in relation to the abnormal cytology result that preceded the diagnosis of the cervical lesion. METHODS: High-grade cervical lesions are reportable conditions in Connecticut for public health surveillance. Telephone interviews and medical record reviews were conducted during 2008-2010 for women (n=269) identified through the surveillance registry. RESULTS: Overall, 43% of women reported history of one or more doses of HPV vaccine. The mean age at vaccination was 22 years. Publicly insured (77%) and uninsured (85%) women were more likely than privately insured women (48%) to report no history of vaccination (P<.05). Among unvaccinated women, being unaware of HPV vaccine was reported significantly more often among Hispanics than non-Hispanics (31% compared with 13%, P=.02) and among those with public or no insurance compared with those with private insurance (26% and 36% compared with 6%, P<.05 for both). The most commonly reported barrier was lack of provider recommendation (25%). Not having talked to a provider about vaccine was reported significantly more often among those with public compared with private insurance (41% compared with 18%, P<.001). Approximately 35% of women received vaccine after an abnormal cytology result; this occurred more frequently among African American women compared with white women (80% compared with 30%, P<.01). CONCLUSION: Catch-up vaccination strategies should focus on provider efforts to increase timely coverage among low-income and minority women.

Racial/Ethnic and poverty disparities in human papillomavirus vaccination completion.

BACKGROUND: Two vaccines against human papillomavirus (HPV), a necessary cause of cervical cancer, are currently licensed and recommended for routine administration in the U.S. to girls in a three-dose series. PURPOSE: This study examined effects of race/ethnicity, poverty, and year on completion of the three-dose HPV vaccine series among those who initiated vaccination. METHODS: Data from the 2008-2009 National Immunization Survey-Teen for girls aged 13-17 years who received at least one dose of HPV vaccine (n=7606) were analyzed in 2010-2011 using logistic regression to adjust for covariates including measures of access to care. RESULTS: During this 2-year period, 55% of adolescent girls who initiated vaccination completed the three-dose series. Completion was significantly higher in 2009 (60%) compared to 2008 (48%; p<0.001). After controlling for covariates, adolescents who were black (AOR=0.48, 95% CI=0.40, 0.57) or Hispanic (AOR=0.75, 95% CI=0.64, 0.88) were significantly less likely to complete vaccination than whites. Adolescents living below the federal poverty level were significantly less likely to complete vaccination than adolescents with household incomes >$75,000 (AOR=0.76, 95% CI=0.63, 0.92). There was no significant interaction between race/ethnicity and year (p=0.92). Although poverty was associated with lower completion rates in 2008, this association was not observed in 2009 (p<0.05 for poverty-year interaction). CONCLUSIONS: HPV vaccination completion rates increased between 2008 and 2009. However, significant differences by race/ethnicity and poverty were observed, and the racial/ethnic differences persisted.