Ranking states on coverage of cancer-preventing vaccines among adolescents: The influence of imprecision

Anne R. Waldrop, Jennifer Moss, Benmei Liu, Li Zhu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Identifying the best and worst states for coverage of cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision of coverage and ranks is important for avoiding overinterpretation. The objective of this study was to examine states’ vaccination coverage and ranks, as well as the imprecision of these estimates, to inform public health decision making. Methods: We used data on coverage of HepB and HPV vaccines among adolescents aged 13-17 from the 2011-2015 National Immunization Survey-Teen (n = 103 729 from 50 US states and Washington, DC). We calculated coverage, 95% confidence intervals (CIs), and ranks for vaccination coverage in each state, and we generated simultaneous 95% CIs for ranks using a Monte Carlo method with 100 000 simulations. Results: Across years, HepB vaccination coverage was 92.2% (95% CI, 91.8%-92.5%; states’ range, 84.3% in West Virginia to 97.0% in Connecticut). HPV vaccination coverage was 57.4% (95% CI, 56.6%-58.2%; range, 41.8% in Kansas to 78.0% in Rhode Island) for girls and 31.0% (95% CI, 30.3%-31.8%; range, 19.0% in Utah to 59.3% in Rhode Island) for boys. States with the highest and lowest ranks generally had narrow 95% CIs; for example, Rhode Island was ranked first (95% CI, 1-1) and Kansas was ranked 51st (95% CI, 49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise 95% CIs; for example, New York was 26th for girls’ HPV vaccination coverage, but its 95% CI included ranks 18-35. Conclusions: States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be overinterpreted. However, ranks can highlight high-performing and low-performing states to target for further research and vaccination promotion programming.

Original languageEnglish (US)
Pages (from-to)627-636
Number of pages10
JournalPublic Health Reports
Volume132
Issue number6
DOIs
StatePublished - Jan 1 2017

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Cancer Vaccines
Confidence Intervals
Vaccination
Hepatitis B
Public Health
Papillomavirus Vaccines
Monte Carlo Method
Immunization Programs
Immunization
Decision Making

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

@article{97533699b7364a70954c4b46351090e1,
title = "Ranking states on coverage of cancer-preventing vaccines among adolescents: The influence of imprecision",
abstract = "Objectives: Identifying the best and worst states for coverage of cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision of coverage and ranks is important for avoiding overinterpretation. The objective of this study was to examine states’ vaccination coverage and ranks, as well as the imprecision of these estimates, to inform public health decision making. Methods: We used data on coverage of HepB and HPV vaccines among adolescents aged 13-17 from the 2011-2015 National Immunization Survey-Teen (n = 103 729 from 50 US states and Washington, DC). We calculated coverage, 95{\%} confidence intervals (CIs), and ranks for vaccination coverage in each state, and we generated simultaneous 95{\%} CIs for ranks using a Monte Carlo method with 100 000 simulations. Results: Across years, HepB vaccination coverage was 92.2{\%} (95{\%} CI, 91.8{\%}-92.5{\%}; states’ range, 84.3{\%} in West Virginia to 97.0{\%} in Connecticut). HPV vaccination coverage was 57.4{\%} (95{\%} CI, 56.6{\%}-58.2{\%}; range, 41.8{\%} in Kansas to 78.0{\%} in Rhode Island) for girls and 31.0{\%} (95{\%} CI, 30.3{\%}-31.8{\%}; range, 19.0{\%} in Utah to 59.3{\%} in Rhode Island) for boys. States with the highest and lowest ranks generally had narrow 95{\%} CIs; for example, Rhode Island was ranked first (95{\%} CI, 1-1) and Kansas was ranked 51st (95{\%} CI, 49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise 95{\%} CIs; for example, New York was 26th for girls’ HPV vaccination coverage, but its 95{\%} CI included ranks 18-35. Conclusions: States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be overinterpreted. However, ranks can highlight high-performing and low-performing states to target for further research and vaccination promotion programming.",
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Ranking states on coverage of cancer-preventing vaccines among adolescents : The influence of imprecision. / Waldrop, Anne R.; Moss, Jennifer; Liu, Benmei; Zhu, Li.

In: Public Health Reports, Vol. 132, No. 6, 01.01.2017, p. 627-636.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ranking states on coverage of cancer-preventing vaccines among adolescents

T2 - The influence of imprecision

AU - Waldrop, Anne R.

AU - Moss, Jennifer

AU - Liu, Benmei

AU - Zhu, Li

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objectives: Identifying the best and worst states for coverage of cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision of coverage and ranks is important for avoiding overinterpretation. The objective of this study was to examine states’ vaccination coverage and ranks, as well as the imprecision of these estimates, to inform public health decision making. Methods: We used data on coverage of HepB and HPV vaccines among adolescents aged 13-17 from the 2011-2015 National Immunization Survey-Teen (n = 103 729 from 50 US states and Washington, DC). We calculated coverage, 95% confidence intervals (CIs), and ranks for vaccination coverage in each state, and we generated simultaneous 95% CIs for ranks using a Monte Carlo method with 100 000 simulations. Results: Across years, HepB vaccination coverage was 92.2% (95% CI, 91.8%-92.5%; states’ range, 84.3% in West Virginia to 97.0% in Connecticut). HPV vaccination coverage was 57.4% (95% CI, 56.6%-58.2%; range, 41.8% in Kansas to 78.0% in Rhode Island) for girls and 31.0% (95% CI, 30.3%-31.8%; range, 19.0% in Utah to 59.3% in Rhode Island) for boys. States with the highest and lowest ranks generally had narrow 95% CIs; for example, Rhode Island was ranked first (95% CI, 1-1) and Kansas was ranked 51st (95% CI, 49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise 95% CIs; for example, New York was 26th for girls’ HPV vaccination coverage, but its 95% CI included ranks 18-35. Conclusions: States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be overinterpreted. However, ranks can highlight high-performing and low-performing states to target for further research and vaccination promotion programming.

AB - Objectives: Identifying the best and worst states for coverage of cancer-preventing vaccines (hepatitis B [HepB] and human papillomavirus [HPV]) may guide public health officials in developing programs, such as promotion campaigns. However, acknowledging the imprecision of coverage and ranks is important for avoiding overinterpretation. The objective of this study was to examine states’ vaccination coverage and ranks, as well as the imprecision of these estimates, to inform public health decision making. Methods: We used data on coverage of HepB and HPV vaccines among adolescents aged 13-17 from the 2011-2015 National Immunization Survey-Teen (n = 103 729 from 50 US states and Washington, DC). We calculated coverage, 95% confidence intervals (CIs), and ranks for vaccination coverage in each state, and we generated simultaneous 95% CIs for ranks using a Monte Carlo method with 100 000 simulations. Results: Across years, HepB vaccination coverage was 92.2% (95% CI, 91.8%-92.5%; states’ range, 84.3% in West Virginia to 97.0% in Connecticut). HPV vaccination coverage was 57.4% (95% CI, 56.6%-58.2%; range, 41.8% in Kansas to 78.0% in Rhode Island) for girls and 31.0% (95% CI, 30.3%-31.8%; range, 19.0% in Utah to 59.3% in Rhode Island) for boys. States with the highest and lowest ranks generally had narrow 95% CIs; for example, Rhode Island was ranked first (95% CI, 1-1) and Kansas was ranked 51st (95% CI, 49-51) for girls’ HPV vaccination. However, states with intermediate ranks had wider and more imprecise 95% CIs; for example, New York was 26th for girls’ HPV vaccination coverage, but its 95% CI included ranks 18-35. Conclusions: States’ ranks of coverage of cancer-preventing vaccines were imprecise, especially for states in the middle of the range; thus, performance rankings presented without measures of imprecision could be overinterpreted. However, ranks can highlight high-performing and low-performing states to target for further research and vaccination promotion programming.

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