Higher Human Papillomavirus Vaccination Coverage Among American Indian and Alaska Native Adolescents and Rural Adolescents in Alaska.
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PURPOSE: Human papillomavirus (HPV) related cancer incidence is higher among American Indian/Alaska Native (AI/AN) women than among White women. Limited access to health care or preventive services in rural communities might increase cancer risk among AI/AN people. To understand disparities in Alaska, this study compares rural/urban HPV vaccination rates of AI/AN with non-AI/AN people. METHODS: Immunization rate data were extracted for each year during 2018-2023. Immunization rates from the Alaska Immunization Information System (VacTrAK) were compared between AI/AN and non-AI/AN people. RESULTS: From 2018 to 2023, HPV vaccine series completion among Alaska adolescents aged 13-15 years ranged from 32% to 39%, with 32% up to date in 2023; 48% had initiated vaccination. AI/AN adolescents had significantly higher completion than non-AI/AN peers (48% vs. 29%, p < 0.01), with consistently higher coverage across years and in both rural and urban settings after stratification; rural coverage was higher overall. Regional disparities were substantial, with series completion ranging from 15% to 58%. CONCLUSIONS: HPV vaccination coverage among Alaska adolescents remained low from 2018 to 2023, with substantial decline between initiation and series completion. AI/AN adolescents had significantly higher coverage than non-AI/AN peers, challenging assumptions about access and highlighting the effectiveness of community-centered, Tribal-led vaccination efforts. Persistent regional and urban-rural disparities, along with recent declines in AI/AN coverage, underscore the need to strengthen equitable strategies and improve series completion.