School of Medicine and Health Sciences Poster Presentations

Title

Ranking states on adolescent coverage with cancer-preventing vaccines: The influence of imprecision

Document Type

Poster

Keywords

Cancer Prevention; State Health Policy; Human Papillomavirus (HPV) Vaccination; Hepatitis B (HepB) Vaccination

Publication Date

Spring 2017

Abstract

Purpose. Identifying the “best” and “worst” states for coverage with cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision around performance ranks is important for avoiding over-interpretation.

Methods. Data on coverage of HepB and HPV vaccines among 13- to 17-year-old adolescents came from 2011-2015 National Immunization Survey-Teen (n=103,729 from 50 states and Washington D.C.). We calculated coverage, 95% confidence intervals (CI’s), and ranks for vaccination coverage in each state, and generated simultaneous CI’s around ranks through a Monte Carlo method with 100,000 simulations.

Results. Across years, HepB vaccination coverage was 92% (95% CI=92-93%; states’ range: 84-97%). HPV vaccination coverage was 57% (95% CI=57-58%; range: 42-78%) for girls and 31% (95% CI=30-32%; range: 19-59%) for boys. States with the highest and lowest ranks generally had narrow CI’s; for example, Rhode Island was ranked 1st (95% CI=1-1) and Kansas was 51st (95% CI=49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise CI’s; for example, New York was 27th for girls’ HPV vaccination coverage, but its CI included ranks 18-35.

Conclusions. Coverage varied considerably by vaccination and by state. States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be over-interpreted. However, ranks can still highlight especially high- and low-performing states to target for further research and vaccination promotion programming.

Keywords: Cancer Prevention; State Health Policy; Human Papillomavirus (HPV) Vaccination; Hepatitis B (HepB) Vaccination

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster to be presented at GW Annual Research Days 2017.

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Ranking states on adolescent coverage with cancer-preventing vaccines: The influence of imprecision

Purpose. Identifying the “best” and “worst” states for coverage with cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision around performance ranks is important for avoiding over-interpretation.

Methods. Data on coverage of HepB and HPV vaccines among 13- to 17-year-old adolescents came from 2011-2015 National Immunization Survey-Teen (n=103,729 from 50 states and Washington D.C.). We calculated coverage, 95% confidence intervals (CI’s), and ranks for vaccination coverage in each state, and generated simultaneous CI’s around ranks through a Monte Carlo method with 100,000 simulations.

Results. Across years, HepB vaccination coverage was 92% (95% CI=92-93%; states’ range: 84-97%). HPV vaccination coverage was 57% (95% CI=57-58%; range: 42-78%) for girls and 31% (95% CI=30-32%; range: 19-59%) for boys. States with the highest and lowest ranks generally had narrow CI’s; for example, Rhode Island was ranked 1st (95% CI=1-1) and Kansas was 51st (95% CI=49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise CI’s; for example, New York was 27th for girls’ HPV vaccination coverage, but its CI included ranks 18-35.

Conclusions. Coverage varied considerably by vaccination and by state. States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be over-interpreted. However, ranks can still highlight especially high- and low-performing states to target for further research and vaccination promotion programming.

Keywords: Cancer Prevention; State Health Policy; Human Papillomavirus (HPV) Vaccination; Hepatitis B (HepB) Vaccination