Abstract
PURPOSE: To evaluate whether HPV vaccination prevalence among eligible U.S. individuals has increased steadily since vaccine introduction and to characterize trends across demographic subgroups. METHODS: Using National Health and Nutrition Examination Survey data (2007-August 2023) among individuals aged 9-26 years, we assessed trends in HPV vaccination prevalence (≥ 1 dose) with joinpoint regression to identify inflection points and estimate annual percent changes (APCs). Analyses were stratified by sex, age, and race/ethnicity. RESULTS: Vaccination prevalence increased from 14.1% (95% CI, 10.1-19.3) in 2007-2008 to 49.1% (95% CI, 44.5-53.7) in 2021-2023 (APC, 6.8%; p = 0.001). Females experienced an early sharp rise (APC, 24.0%; p < 0.001) through 2011-2012, followed by slower growth thereafter (APC, 3.7%; p = 0.004). Male vaccination increased steadily (APC, 11.3%; p < 0.001). By 2021-2023, prevalence was highest among 13-17-year-olds (58.2%) and lowest among 9-12-year-olds (26.2%). Black individuals had the lowest vaccination prevalence of any racial/ethnic group (29.3%) and experienced a reversal of prior gains after 2015-2016 (APC, - 2.3%; p = 0.34). CONCLUSIONS: HPV vaccination prevalence more than tripled between 2007 and 2023, but the pace of growth slowed among females and reversed among Black individuals, which may exacerbate existing disparities in HPV-related cancer burden.