HPV Vaccination Uptake for Adolescent Girls Enrolled in Texas Medicaid and Chip: 2006 - 2008

Background: Each year in the United States, 12,000 women are diagnosed and 4,000 women die from cervical cancer. Most cervical cancer cases can be prevented with high coverage rates of the HPV vaccine.

Objectives: To estimate the association between HPV vaccine uptake and important girls’ characteristics (age, race/ethnicity, program component, and area of residence) among 9-17 year olds enrolled in Texas Medicaid or the state children’s health insurance program (CHIP) from June 2006 to December 2008.

Methods: We assessed whether each girl received at least one dose of the HPV vaccine by examining Medicaid and CHIP claims and encounter data. We then estimated the association between HPV vaccine uptake and girls’ characteristics for girls enrolled at least one month during the time period and for girls enrolled in December 2008.

Results: Overall, 15% of the 700,429 girls enrolled in Texas Medicaid and CHIP from June 2006 to December 2008 received > 1 dose of the HPV vaccine. By December 2008, uptake was 19%. Uptake was higher among girls in Medicaid (20%) than CHIP (13%). Within Medicaid, HPV vaccine uptake was highest in Primary Care Case Management (25%) compared to the Managed Care (20%) and Fee for Service programs (14%). HPV vaccine uptake differed substantially by age: 9-10 year olds (4%), 11-12 year olds (20%), 13-14 year olds (28%), 15-17 year olds (23%). Hispanic girls (23%) were more likely to have received the vaccine than non-Hispanic Whites (15%) and non-Hispanic Blacks (13%). Uptake in urban and large rural areas (20%) was higher than in small rural or isolated areas (14%).

Conclusions: Within Texas, HPV vaccine uptake is much lower among Medicaid and CHIP than among the general population (37%, National Immunization Survey). Disparities in HPV vaccine uptake need to be addressed to prevent widening of cervical cancer morbidity and mortality disparities.