Human Papillomavirus Vaccination and Human Papillomavirus-Associated Cancer Rates Within Florida Counties

Introduction: To direct interventions, the Florida counties with the greatest risk of current and future human papillomavirus-associated cancers were identified by estimating county level (1) percentages of adolescents aged 13-17 years who initiated (>= 1 dose) and were up to date (2-3 doses) for the human papillomavirus vaccine and (2) human papillomavirus-associ-ated cancer incidence rates. Methods: Records were obtained for human papillomavirus vaccinations from the Florida immunization registry (2006-2019), incident cancer cases from the Florida registry (2013-2017), and annual population counts from the Florida Department of Health (2006-2019). In 2020, annual county-level human papillomavirus vaccine initiation, human papillomavirus vaccine up-to-date, and age-adjusted human papillomavirus-associated cancer incidence rates were estimated. Results: Among adolescents aged 13-17 years, average 2018-2019 county-specific human papillomavirus vaccine initiation ranged from 38% to 100% for females and from 34% to 96% for males. Up-to-date estimates ranged from 20% to 72% for females and from 24% to 77% for males. The majority (78%) of counties with initiation and up-to-date estimates within the lowest tercile were located in Northern Florida. County-specific 2013-2017 annualized, adjusted human papillomavirus-associated cancer incidence rates ranged from 0 to 29.8 per 100,000 among females and from 5.4 to 24.1 per 100,000 among males. Counties within the highest tercile for human papillomavirus-associated cancers were primarily (90% for females and 77% for males) located in Northern Florida. Conclusions: Human papillomavirus-associated cancer risk varies widely across Florida counties, with particularly high risk within Northern Florida. Targeting interventions toward counties with low vaccination and high cancer rates may reduce human papillomavirus-associated cancers. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.