The Affordable Care Act and change in human papillomavirus (HPV) vaccine uptake in the United States
Document Type
Article
Abstract
Background Human papillomavirus (HPV) vaccination uptake has increased in the United States yet continues to fall short of the Healthy People 2030 goal. Cost of care is a known barrier. The Affordable Care Act (ACA) aimed to enhance access to preventive healthcare services, including HPV vaccination. Our study examined the association between the ACA and known vaccination-enabling factors in the United States.
Methods We analyzed data from 29,216 adults aged 18–26 in the National Health Interview Survey from 2011 to 2017. Changes in vaccination-enabling factors (regular physician visitation and changes in health insurance status) and HPV vaccination status pre- (2011–2013; n = 13,494) to post-ACA (2014–2017; n = 15,722) were assessed using logistic regression models adjusted for poverty, education, marital status, comorbidities, sex, and geography.
Results A total of 13,494 and 15,722 eligible individuals were identified pre- and post-ACA, respectively. Post-ACA, the proportion of individuals reporting receipt of one dose of the HPV vaccine increased by 43 % (3.9 % to 5.5 %; OR 1.45, 95 % CI 1.24, 1.70; p < .001), with significant gains among non-Hispanic White (OR 1.55, 95 % CI 1.24, 1.94) and Black individuals (OR 1.59, 95 % CI 1.12, 2.29). Completion of ≥2 doses rose from 12.5 % to 17.8 % (OR 1.62, 95 % CI 1.47, 1.79), notably among Hispanic individuals (7.6 % to 14.7 %, OR interaction = 1.36, 95 % CI 1.05, 1.77; p = .020). Post-ACA, there was a significant decrease in uninsured rates and an increase in vaccination completion odds among individuals privately insured (OR 1.36, 95 % CI 1.22, 1.52; p < .001) and those insured by Medicaid (OR 1.81, 95 % CI 1.35, 2.43; p < .001). Regular physician visits also rose pre- to post-ACA (53.1 % to 57.1 %, OR 1.17, 95 % CI 1.09, 1.25; p < .001).
Conclusion The ACA has been associated with increased HPV vaccination uptake, especially among racial/ethnic minorities, gains likely driven by an increase in vaccination-enabling factors such as decreased uninsurance and increased access to physician visits.
DOI
https://doi.org/10.1016/j.vaccine.2025.126842
Publication Date
3-19-2025
Recommended Citation
Semprini, Jason; Gao, May Z.; Awonusi, Oluwaseyi O.; Ramkumar, Shreya P.; Myint, Janine A.; Barnes, Justin M.; Adjei Boakye, Eric; Rohde, Rebecca L.; Zimet, Gregory D.; and Osazuwa-Peters, Nosayaba, "The Affordable Care Act and change in human papillomavirus (HPV) vaccine uptake in the United States" (2025). Public Health. 42.
https://digitalcommons.dmu.edu/fac_ph/42
