In the 2016 and 2017 National Immunization Survey – Teen, disparities in HPV vaccination coverage by metropolitan statistical area (MSA) status were observed (NIS-Teen). In 2017, adolescents living in non-MSAs had 11 percentage points lower HPV vaccination initiation (1dose) coverage and those living in MSA, non-principal cities had 7 percentage points lower coverage than those living in MSA, principal cities. The researchers looked at trends in HPV vaccine initiation by MSA status from 2013 to 2017 to see how this disparity has changed over time. Annual percentage point changes in HPV vaccination initiation were estimated using weighted linear regression by survey year. The average annual percentage point increase in HPV vaccination initiation coverage over a five-year period was 5.2 in mostly urban areas, 4.9 in mostly suburban areas, and 5.2 in mostly rural areas. Despite increases in each MSA, coverage in predominantly rural areas was consistently and significantly lower than coverage in predominantly urban areas. Except for black, non-Hispanic adolescents, coverage was significantly lower among teens living in mostly rural areas, regardless of poverty status, gender, or race/ethnicity.

The magnitude of the disparity between mostly urban and mostly rural areas did not change significantly over time. To identify and implement targeted strategies to improve HPV vaccination coverage and reduce disparities, a better understanding of the facilitators and barriers to HPV vaccination in mostly rural areas is required.