11. Addressing Cervical Cancer Disparities in Adolescents with Disabilities through HPV Vaccination

Background

Adolescents with disabilities (AWD) are often viewed as nonsexual, posing challenges in receiving sexual healthcare. Yet, patients with disabilities have higher rates of sexual abuse and unprotected sex and lower rates of cervical cancer screening. It is critical that AWD receive the HPV vaccination due to their risk of HPV exposure and lower likelihood of receiving routine cervical cancer screening. This study aims to assess if there is a discrepancy in HPV vaccination between AWD and their non-disabled peers.

Methods

A retrospective cohort study was conducted of adolescent females ages 16-21 years attending any visit in an academic health system from July 2021 - September 2024. Data collected included demographics, disability status, and receiving at least one dose of the HPV vaccine. Disability status was defined by the Children with Disabilities Algorithm (Agency for Healthcare Research and Quality), which uses ICD-9 codes to classify physical, sensory, developmental/behavioral, psychological, and intellectual disabilities. The primary outcome was differences in HPV vaccination between adolescents with specific disabilities, any disability, and non-disabled peers. Analysis included Chi-square tests and logistic regression. This study was exempt by IRB.

Results

Of 7,801 total adolescents, 1,132 (14.5%) were identified as having any disability, 5,785 (74.2%) of all patients received at least one dose of the HPV vaccine, and 870 (76.9%) patients with disabilities received at least one dose. Any disability was associated with higher HPV vaccination rate (p=0.025). Psychological and sensory disabilities were significantly associated with higher HPV vaccination rates (p=0.011; p=0.039), whereas intellectual disability was nearly significantly associated with lower HPV vaccination rates (p=0.07). Physical and developmental disabilities were not associated with HPV vaccination. Compared to white race, non-Black racial minorities had a significantly higher HPV vaccination rate (p=0.031). There was no significant difference between HPV vaccination among disabilities according to race. Older age was significantly associated with HPV vaccination (p=0.006). See Table 1.

Conclusions

Adolescents with psychological and sensory disabilities had higher HPV vaccination rates, suggesting lower cervical cancer risk. However, adolescents with intellectual disabilities may experience lower rates, exposing a potential disparity in cervical cancer risk. Providing patients and parents with education on HPV exposure and cancer risk tailored to the adolescent's disability may decrease barriers to HPV vaccination.