Affordable Care Act state Medicaid expansion and human papillomavirus vaccination among adolescent and young adult US women: A national study

Objective: To ascertain the impact of Affordable Care Act (ACA) state Medicaid expansion on human papillomavirus (HPV) vaccination among both adolescent and young adult US women. Data Sources: We used state-level data on ACA Medicaid expansion and individuallevel data on US women aged 15-25 years living at or below 138% of the Federal Poverty Level (FPL) from the 2011-2017 waves of the National Survey of Family Growth (N = 2408). Study Design: We conducted a quasi-experimental study examining the association between ACA state Medicaid expansion and HPV vaccination initiation among eligible adolescent and young adult US women. Methods: We used linear probability modeling within a difference-in-differences approach, adjusting for individual- and state-level covariates. Principal Findings: Adjusting for individual- and state-level covariates, we found a negative association between Medicaid expansion and HPV vaccination among US women aged 15-25 years living in low-income households in the first year post-expansion (coefficient: -15.9 percentage points; 95% confidence interval [CI]: -30.1, -1.6 points). In contrast, we observed a positive association in the third year post-expansion (coefficient: 20.5 percentage points; 95% confidence interval [CI]: -1.8, 42.9 points). Conclusions: Medicaid expansion may have increased HPV vaccination among adolescent and young adult US women over time. Additional research is needed to identify the mechanisms and differential effects of Medicaid expansion on HPV vaccination among diverse subgroups of US women. KEYWORDS adolescents, human papillomavirus vaccination, Medicaid expansion, women, young adults What is known about the topic * Uptake of the human papillomavirus (HPV) vaccine has been slow and remains below Healthy People 2030 targets. * Affordable Care Act (ACA) state Medicaid expansion increased HPV vaccination among US adolescents aged 13-17 years. * Limited information exists on the impact of ACA Medicaid expansion on US young adults. What this study adds * ACA Medicaid expansion was associated with HPV vaccination among US women aged 15-25 years in the first three years post-expansion. * There was a positive association between ACA Medicaid expansion and HPV vaccination among adolescent and young adult US women in the third year post-expansion. * ACA Medicaid expansion may have increased HPV vaccine uptake among both adolescent and young adult US women over time.
1 | INTRODUCTION Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) in the United States. (1) Data suggest that, in 2013-2016, the prevalence of any HPV Infection [...]