Background/Purpose: Autoimmune diseases such as lupus and inflammatory bowel disease are associated with increased rates of human papillomavirus (HPV), the most common sexually transmitted disease and the primary cause of cervical cancer. In 2006 and 2009 the U.S. Food and Drug Administration approved two 3-dose series HPV vaccines for use in 9-26 year-old females and males. Studies show the HPV vaccine to be safe and efficacious in patients with autoimmune diseases. We investigated whether HPV vaccine uptake is higher among those with autoimmune diseases compared to the general population.          

Methods: Using a U.S. commercial insurance claims database from 2005-2012, we identified children and young adults age 9-26 with ≥12 months of continuous enrollment and ≥2 autoimmune disease diagnosis codes ≥7 days apart. We defined the index date as the calendar month and year of the second autoimmune disease diagnosis code. We matched these individuals by age, sex, and index date to randomly selected controls without any autoimmune disease diagnosis codes (1:4 ratio). We excluded individuals with a history of malignancy or organ transplant. Vaccination was defined as ≥1 HPV vaccine code (CPT 90649 or 90650) following the index date, after 2006. Baseline covariates for stratified analyses included age, sex, region, healthcare utilization and comorbidities. We also examined vaccine uptake in the 21 states that passed HPV-related legislation from 2008-2012, compared to states that did not. We obtained p-values comparing proportions of HPV vaccine uptake in the two cohorts.

Results: We identified 29,255 children and young adults with autoimmune diseases and 117,020 without. The mean age was 19 years (SD 5); 59% were female. The autoimmune disease cohort had a higher number of physician visits, abnormal pap smears, and sexually transmitted diseases (all p-values<0.01). Both cohorts had low percentages of HPV vaccine uptake overall, with 8.5% with autoimmune diseases and 9.1% without receiving ≥1 vaccine (p=0.34) (Table). Among females, 13.1% with autoimmune diseases and 14.1% without received ≥1 vaccine (p<0.01); <5% of females in both groups completed a 3-dose series (p=0.57). Vaccinations were equally distributed geographically except for the Northeast which had a higher percent with autoimmune diseases receiving ≥1 HPV vaccine (p=0.02). In states with HPV-related legislation, 7.1% with autoimmune diseases and 7.5% without received ≥1 vaccine, compared to 6.5% with autoimmune diseases (p=0.04) and 7.4% without (p=0.5) in states without legislation.

Conclusion: HPV vaccine uptake is profoundly low among children and young adults both with and without autoimmune diseases despite its known efficacy. Heightened public health efforts are necessary for the general population and for those with autoimmune diseases given their increased risk of persistent HPV infection.

Table. HPV Vaccine Uptake Among Children and Young Adults in the U.S. With and Without Autoimmune Diseases*
	Autoimmune Disease Cohort* N=29,255	Non-autoimmune Disease Cohort N=117,020	p-value
Abnormal Pap Smears at Baseline	549 (1.9)	1698 (1.5)	<0.01
HPV Vaccine: Overall – N(%)
≥1	2495 (8.5)	10680 (9.1)	0.34
3 (Completed series)	866 (3)	3364 (2.9)	0.87
HPV Vaccine: Females- N(%)
≥1	2388 (13.7)	10264 (14.1)	<0.01
3	861 (4.7)	3343 (4.6)	0.57
HPV Vaccine: Males- N(%)
≥1	107 (0.97)	416 (0.90)	0.49
3	5 (0.1)	21 (0.1)	0.99
≥1 HPV vaccine: Females by age group – N(%)	N= 2388	N=10264
9-14	872 (36.6)	2734 (37.4)	0.47
15-20	1045 (43.7)	4319 (41.1)	0.02
21-26	471 (19.7)	2111 (20.6)	0.33
≥1 HPV vaccine: Males by age group – N(%)	N=107	N=416
9-14	70 (65.5)	225 (54.1)	0.03
15-20	33 (30.8)	171 (41.2)	0.05
21-26	4 (3.7)	20 (4.8)	0.63
≥1 HPV vaccine by U.S. region– N(%)
Northeast	406 (16.3)	1264 (11.8)	0.02
Midwest	694 (27.8)	3325 (31.1)	0.09
South	1034 (41.4)	4433 (41.5)	0.95
West	361 (14.5)	1654 (15.5)	0.63
*Autoimmune diseases include: juvenile idiopathic arthritis, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, psoriatic arthritis, inflammatory bowel disease, vasculitis, multiple sclerosis, dermatomyositis, scleroderma, ankylosing spondylitis, Goodpasture’s syndrome, and sarcoidosis.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-papillomavirus-vaccine-uptake-among-children-and-young-adults-with-autoimmune-diseases/