Race/Ethnicity, Human Papillomavirus Vaccination Status, and Papanicolaou Test Uptake Among 27-45-Year-Old Women: A Cross-Sectional Analysis of 2019-2022 Behavioral Risk Factor Surveillance System Data.

Abstract

Purpose: The human papillomavirus (HPV) vaccine was recently approved for 27-45-year-olds. We examined the association between HPV vaccination status and having an up-to-date Papanicolaou (Pap) test for 27-45-year-old women across racial/ethnic groups.

Methods: We conducted a cross-sectional analysis using 2019-2022 Behavioral Risk Factor Surveillance System data. We performed weighted multivariable logistic regressions to examine the association between being unvaccinated, initiating, and completing the HPV vaccine series and Pap test uptake.

Results: Among 7,052 women, non-Hispanic White (NHW) women had the highest rate of HPV vaccine series completion (14.0%). Non-Hispanic Black (NHB) had the lowest rate of HPV vaccine series completion (9.2%) and the highest rate of up-to-date Pap tests (71.2%). Non-Hispanic Other (NHO) women had the lowest rate of up-to-date Pap tests (52.1%). Completing the HPV vaccine series was associated with increased odds of having an up-to-date Pap test (odds ratio [OR]: 1.66 95% confidence interval [CI]: 1.23-2.24). Among Hispanic and NHW women, HPV vaccine series completion was associated with increased odds of up-to-date Pap testing (Hispanic: OR: 2.16, 95% CI: 1.02-4.58; NHW: OR: 1.49, 95% CI: 1.01-2.21). HPV vaccine series initiation was associated with up-to-date Pap tests for NHB (OR: 2.75, 95% CI: 1.19-6.34) and NHO women (OR: 3.15, 95% CI: 1.56-6.37).

Conclusions: Unvaccinated women had decreased odds of up-to-date Pap testing. Shared clinical decision-making should be utilized to help 27-45-year-old women decide if they want to receive the HPV vaccine; culturally tailored efforts should be made to improve utilization of Pap testing across racial/ethnic groups.