Impact of Social Determinants of Health on HPV Vaccination Rates at a Youth Sexual Health Clinic: A Retrospective Cohort Study
Anita Narkhede, Alisa Vidwans, Victoria Armstrong, Carina A Rodriguez, Lisa J SandersAbstract
Background
Human papillomavirus (HPV) is the most common sexually transmitted infection globally and a leading cause of several cancers, including cervical, anal, and oropharyngeal cancers. Systemic inequities and limited access to care may place certain populations at a disproportionately higher risk of HPV infection and associated conditions. Although HPV vaccination has proven to be a highly effective public health intervention, vaccination rates remain suboptimal. This study examines the association between social determinants of health (SDOH) and HPV vaccination rates in a youth sexual health clinic serving a predominantly underserved community in a metropolitan area in the southeastern United States.
Methods
This study was conducted at a clinic providing sexual health and risk reduction services to patients aged 13–24. Retrospective data analysis was performed from the electronic medical records of 933 patients who fully completed the clinic’s screening form between January 1 and December 31, 2022. Data collected included age, gender, sexual orientation, race, ethnicity, insurance coverage status, risk for homelessness, transportation barriers, food insecurity, and self-reported HPV vaccination status. Associations between SDOH and HPV vaccination status were assessed using chi-square tests.
Results
Among the patient cohort, 59.9% were unvaccinated for HPV. Health insurance coverage was significantly associated with HPV vaccination status, with uninsured individuals demonstrating significantly lower vaccination rates (χ2 = 25.65, p < 0.001). Race was also significantly associated with HPV vaccination rates, with 34.3% of Black patients stating they had received the vaccine compared to 46.1% of White patients (χ2 = 10.39, p = 0.006). Transportation barriers, food insecurity, and risk for homelessness did not show significant associations with HPV vaccination status (χ2 = 0.29, p = 0.59; χ2 = 3.63, p = 0.057; χ2 = 0.11, p = 0.743).
Conclusions
This study highlights the significant impact of SDOH such as lack of insurance coverage and racial disparities on HPV vaccination rates among underserved youth populations. These findings underscore the critical need for interventions targeting systemic barriers to improve vaccination rates and reduce the burden of HPV-related diseases. Future research could investigate larger, more diverse populations and explore additional social and structural factors to better inform public health strategies and promote health equity.