Human Papillomavirus Immunization Policies: Projected Mortality in Economic Strata

Background: The human papilloma virus vaccine may reduce the incidence of cervical cancer which in 2007 accounted for approximately 3,700 deaths in the United States. We examined alternative immunization polices on cervical cancer mortality across economic strata of the U.S. population.

Methods: We used publicly available data on infection rate, population size, and pap smear rate by economic strata to approximate the cervical cancer mortality rate by economic strata. We tested the effects of four immunization and pap smear policies on the cervical cancer mortality rate.

Results: The 4 models predict yearly deaths ranging from 619 to 3700. In all scenarios the greatest reduction in mortality is seen in the lowest socioeconomic bracket. A projected increase in vaccination rate decreases mortalities but leads to increasing disparity between socioeconomic classes. This disparity increases as the vaccination rate approach the pap smear rate for each economic strata. Universal mandatory vaccination could lead to a further reduction in total deaths with no change in disparity. Finally, universal mandatory vaccination with an increase in the pap smear rate would have the greatest reduction on mortality and would have the desired reduction in disparity.

Conclusions: Immunization is particularly important amongst the least affluent populations that are at highest risk for infection and benefit least from effective utilization of pap screening. Without preferential immunization of lower income populations, the model demonstrates that the introduction of the HPV vaccine may lead to lower mortality rates but a greater disparity between individuals of different economic strata.