Regional Differences and Trends Within Texas in HPV Vaccination Among Medicaid-insured Adolescents

Objectives: The purpose of this study was to compare regional HPV vaccination rates and trends among the Texas Medicaid population of adolescents in 2019 to 2021. Methods: We constructed 3 annual cross-sectional cohorts from Texas Medicaid data from 2019 to 2021, including a total of 1 531 301 individuals contributing 2 757 577 person-years of adolescents aged 9-18 for this analysis. The primary outcome was an observed HPV vaccine dose during the study period. We conducted multivariable logistic regression to estimate the odds of HPV vaccination based on region and the socio-demographic predictor variables. Results: Overall, the HPV vaccination incidence rate was 13.1% for Medicaid adolescent clients in Texas. The 2020 and 2021 cohorts were significantly less likely to be vaccinated for HPV than the 2019 cohort. Regional variation was detected for adolescents. Significant differences were observed in both age cohorts by sex, race/ethnicity, urbanicity, and cohort year. Conclusion: Declines in HPV vaccination after the COVID-19 pandemic among Texas Medicaid-insured adolescents are of urgent concern if HPV-related cancers are to be prevented. Furthermore, regional differences are apparent throughout Texas, which may contribute to an unequal burden of future disease.