County-level correlates of missed opportunities for HPV vaccination in Indiana: An environmental scan

Abstract Background The goal of this study was to examine variability across the 92 Indiana counties in missed opportunities for HPV vaccination and to assess county-level correlates of missed opportunities. Methods The Indiana immunization registry provided county level data on 2017 missed opportunity rates for adolescents ages 11–18. A missed opportunity was an encounter when a patient eligible for HPV vaccination received one or more other recommended vaccines, but not HPV. Potential county-level correlates of missed opportunities included race, income, population density, education, primary care providers per capita, smoking rates, mammography screening, diabetes monitoring, and Pap testing. Results The missed opportunity rate ranged from 31% to 85% across Indiana counties. Higher population density, mammography screening, income inequality, and diabetes monitoring were associated with fewer missed opportunities. Conclusions We found wide variability in missed opportunities across counties, which were associated with population density and county-level participation in other health-related behaviors. Sources of support This study was supported by the National Cancer Institute under Award Number P30 CA082709-18S4.