Insurance Continuity and Human Papillomavirus Vaccine Uptake in Oregon and California Federally Qualified Health Centers
Insurance Continuity and Human Papillomavirus Vaccine Uptake in Oregon and California Federally Qualified Health Centers
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DOI：
10.2105/ajph.2014.302007
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发表时间：
2014-09-01
影响因子：
12.7
通讯作者：
DeVoe, Jennifer
中科院分区：
文献类型：
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作者：
Cowburn, Stuart;Carlson, Matthew;DeVoe, Jennifer
目标。我们在联邦合格诊所（fqhc）网络中研究了保险连续性与人乳头瘤病毒（HPV）疫苗摄取之间的关系。我们分析了2008年至2010年9-26岁女性的回顾性电子健康记录数据。根据电子健康记录保险覆盖信息，按研究期间参保时间的百分比（0%、1%-32%、33%-65%、66%-99%和100%）对患者进行分类。我们使用双水平多变量泊松回归来比较按种族/民族和年龄分层的保险组之间的疫苗接种率。我们还调查了至少有12个月时间完成所有3剂疫苗接种的启动者的疫苗系列完成情况。在保险类别、年龄和种族/民族之间观察到显著的相互作用。与持续投保的同龄人相比，如果患者投保时间少于研究期间的66%，年龄在13岁或以上，并且被确定为种族/少数民族，则患者接种HPV疫苗的可能性较小。保险覆盖率与疫苗系列完成度无关。在本研究的fqhc中，尽管许多患者无论支付能力如何都可以获得HPV疫苗，但保险状况在疫苗接种方面存在差异。
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.