Amarachukwu F. Orji

Disparities in human papillomavirus vaccination uptake across the intersection of disability and sexual orientation

Abstract Purpose Although human papillomavirus (HPV) vaccination provides effective primary prevention against cervical cancer, HPV vaccination rates remain low in the U.S. It is unknown whether women with disabilities and/or LGB + women are likely to experience disparities in HPV vaccination uptake. Methods We used data from the 2014–2022 Behavioral Risk Factor Surveillance System ( N  = 40,401) to estimate HPV vaccination rates among women aged 18–44 years. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression models for four subgroups defined by disability status and LGB + status. Analyses were further stratified by age (18–26 years; 27–44 years). Results Overall, only 19% of eligible women had received at least one dose of the HPV vaccine, and 12% had completed the full series. Younger women were more likely than older women to have been vaccinated. Compared with heterosexual women without disabilities, heterosexual women with disabilities, had lower vaccination uptake (heterosexual with disabilities: aPR = 0.95; 95% CI 0.93–0.97; LGB + with disabilities: aPR = 0.97; 95% CI 0.96–0.98), and were 12% less likely to complete the series (heterosexual with disabilities: aPR = 0.88; 95% CI 0.83–0.93). Conclusion HPV vaccination rates remain low, representing missed opportunities for primary prevention. Women with disabilities had lower vaccination rates than women without disabilities and were less likely to complete the vaccine series. These findings, combined with age-stratified results, highlight the need for stronger catch-up campaigns and targeted efforts to address structural barriers related to disability, ultimately improving HPV vaccination coverage and reducing the burden of cervical cancer.

Examining disparities in cervical cancer diagnosis at the intersection of disability and sexual orientation

Cervical cancer risk factors are more prevalent among women with disabilities and sexual minorities, yet little is known about how these factors intersect. To examine differences in cervical cancer diagnosis at the intersection of disability and sexual orientation. Using a nationally representative sample (N = 80,447) obtained from 2014 to 2023 National Health Interview Survey data, we conducted logistic regressions to estimate the odds of cervical cancer diagnosis at the intersection of disability and sexual orientation among women (25-65 years). We calculated three measures of interaction: 1) relative excess risk due to interaction (RERI); 2) proportion attributable to interaction (AP); and 3) synergy index (SI). Heterosexual women with disabilities were more likely to receive a diagnosis of cervical cancer (aOR = 2.15, 95 % CI: 1.75-2.64) compared to heterosexual women without disabilities. This disparity was even greater among women with disabilities who identified as sexual minorities (aOR = 2.98, 95 % CI: 1.86-4.77). The interaction measures suggest a synergistic effect between disability and sexual orientation on cervical cancer risk. Specifically, women with disabilities in multiple functional areas had increased odds of a cervical cancer diagnosis, regardless of sexual orientation (Heterosexual: aOR = 2.94, 95 % CI: 2.33-3.70; Sexual minorities: aOR = 3.04, 95 % CI: 1.25-7.42). The findings suggest that disability status plays a significant role in exacerbating the risk of cervical cancer, while the combination of disability and minority sexual orientation may further compound adverse experiences that disproportionately contribute to this risk.

Assessing Disparities in Cervical Cancer Screening with Pap Test by Disability Types

Prior research has found that women with disabilities have often experienced disparities in receipt of cervical cancer screening. However, there is a research gap regarding receipt of cervical cancer screening by types of disability. This study examined the differences in receiving cervical cancer screening through self-reported Pap testing among women by disability type. This cross-sectional study analyzed data from the 2016, 2018, and 2020 Behavioral Risk Factor and Surveillance System (BRFSS). The relative risk of cervical cancer screening through self-reported Pap tests received within the past three years among women aged 21-65 by disability type was compared using modified Poisson regression with robust error variance. A total of 307,142 women from across the USA were sampled. In every disability group, older women were significantly less likely to receive Pap tests than their counterparts without disabilities. Women with multiple disabilities (aRR=0.91; 95% CI, 0.89-0.94) and those with ambulatory disabilities (aRR=0.93; 95% CI, 0.91-0.97) reported being less likely to receive Pap tests than women with no disability. Ambulatory disability and multiple disabilities are associated with a lower likelihood of cervical cancer screening with Pap test, increasing the need to eliminate disability-specific disparities in Pap testing. Future efforts should focus on improving cancer education programs tailored to the needs of women with disabilities, addressing barriers related to mobility and access to healthcare services, and ensuring equitable access to preventive screenings.