Purpose: The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among young women aged 18-26 in Texas using multilevel, small area estimation.
Methods: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (receipt of ≥ 1 dose Gardasil®) from the 2008 Behavioral Risk Factor Surveillance System and a number of secondary sources. Using the parameters from the final model, we simulated HPV vaccine coverage in each county.
Results: Indirect county-level estimates ranged from 1.9-23.8%, with a weighted state average of 11.4%. The counties with the highest and lowest coverage estimates were Orange County, TX and Webb County, TX respectively. Significant correlations were observed between HPV vaccination and age, Hispanic ethnicity, and the percentage of uninsured at the county and public health region levels.
Conclusions: Small area analyses have been used in a variety of settings to assess a variety of health outcomes, and as shown in this study, can be used to highlight geographic disparities and opportunities for intervention in HPV vaccine coverage.