Disparities in human papillomavirus vaccination uptake across the intersection of disability and sexual orientation.

Abstract

Purpose: Although human papillomavirus (HPV) vaccination provides effective primary prevention against cervical cancer, HPV vaccination rates remain low in the U.S. It is unknown whether women with disabilities and/or LGB + women are likely to experience disparities in HPV vaccination uptake.

Methods: We used data from the 2014-2022 Behavioral Risk Factor Surveillance System (N = 40,401) to estimate HPV vaccination rates among women aged 18-44 years. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression models for four subgroups defined by disability status and LGB + status. Analyses were further stratified by age (18-26 years; 27-44 years).

Results: Overall, only 19% of eligible women had received at least one dose of the HPV vaccine, and 12% had completed the full series. Younger women were more likely than older women to have been vaccinated. Compared with heterosexual women without disabilities, heterosexual women with disabilities, had lower vaccination uptake (heterosexual with disabilities: aPR = 0.95; 95% CI 0.93-0.97; LGB + with disabilities: aPR = 0.97; 95% CI 0.96-0.98), and were 12% less likely to complete the series (heterosexual with disabilities: aPR = 0.88; 95% CI 0.83-0.93).

Conclusion: HPV vaccination rates remain low, representing missed opportunities for primary prevention. Women with disabilities had lower vaccination rates than women without disabilities and were less likely to complete the vaccine series. These findings, combined with age-stratified results, highlight the need for stronger catch-up campaigns and targeted efforts to address structural barriers related to disability, ultimately improving HPV vaccination coverage and reducing the burden of cervical cancer.