Human Papillomavirus Vaccine Administration Trends Among Commercially Insured US Adults Aged 27-45 Years Before and After Advisory Committee on Immunization Practices Recommendation Change, 2007-2020

IMPORTANCE In 2019, the Advisory Committee on Immunization Practices (ACIP) recommended patient-clinician shared decision-making for human papillomavirus (HPV) vaccination in adults aged 27 to 45 years. Less is known about the HPV vaccine administration trends in this age group before and after this recommendation update. OBJECTIVE To examine the association between the ACIP recommendation update and the HPV vaccine administration among US adults aged 27 to 45 years. DESIGN, SETTING, AND PARTICIPANTS This large commercial claim-based retrospective cohort study used the Optum Clinformatics database for validated claims from January 1, 2007, through December 31, 2020. A total of 22 600 520 US adults aged 27 to 45 years without previous HPV vaccination claims during the study and enrollment period were included. MAIN OUTCOMES AND MEASURES The first-appearing HPV vaccination claim per individual was defined as a new HPV vaccine administration. Interrupted time-series analyses were conducted to assess the association between the ACIP update and the quarterly vaccine administration rate change. The annual rate trends across race and ethnicity groups and the proportions of vaccination cases by sub-age groups and valent types were also estimated. Vaccine administration trends were assessed by race and ethnicity in this age group because HPV vaccination trends were found to differ by race and ethnicity in the initially eligible population. RESULTS Among 22 600520 final study participants, the majoritywere men (50.9%) and non-Hispanic White (53.4%), and the mean (SD) age when first observedwas 34.6 (5.8) years. In women, the ACIP updatewas associated with an immediate increase in vaccine administration rate (coefficient beta(2), 40.18 per 100000 persons; P =.01) and an increased slope (coefficient beta(3), 9.62per 100000 persons per quarter; P =.03) over time postupdate. The ACIP updatewas only associated with an immediate increase in vaccine administration inmen(coefficient beta(2), 27.54; P <.001). The annual rate trendswere similar across race and ethnicity groups. Age at vaccine administration shifted over time (eg, women aged 40-45 years comprised only 4.9% of vaccinations in 2017, then 19.0% in 2019, and 22.7% in 2020). The most administered HPV vaccines in 2020were 9 valent (women, 97.0%; men, 97.7%). CONCLUSIONS AND RELEVANCE In this population-based cohort study, there were statistically significant increases in HPV vaccine administration in adults aged 27 to 45 years after the ACIP recommendation update. Patient-clinician shared decision-makingmay have been the main associated factor for this increase. Further research is warranted to explore the decision-making process in receiving HPV vaccination and to develop effective decision aids to maximize the cancer prevention benefit in this age group.