Importance: Studies disagree about whether human papillomavirus (HPV) vaccination uptake differs meaningfully among racial and ethnic groups, an important issue given large disparities in some HPV-associated cancers.

Objective: To comprehensively characterize racial and ethnic differences in HPV vaccine initiation and follow-through.

Data Sources: We systematically searched PubMed, CINAHL, Embase, and Web of Science to identify US studies from 2006 through mid-2017 reporting the association of race and ethnicity with HPV vaccination. We identified 118 studies (n=3,095,486) that met inclusion criteria.

Study Selection: Included studies were published in English and reported HPV vaccine initiation or follow-through in the US with at least one comparison by race or ethnicity.

Data Extraction and Synthesis: We synthesized effect sizes using random effects meta-analysis for Blacks, Hispanics, and Asians as well as for all minority groups combined. We stratified results by source of vaccination data (self-reported or provider-verified). We used meta-regression to identify study characteristics associated with the size and direction of racial/ethnic differences in vaccination.

Main Outcomes and Measures: The effect size was the risk difference, the percentage point difference between White and one or more racial or ethnic minority groups in HPV vaccine initiation and in follow-through.

Results: HPV vaccine initiation showed no racial or ethnic differences overall. However, among studies of provider-verified vaccination, minorities were 6.1% [3.3%-8.8%] more likely than Whites to initiate HPV vaccination. This reverse disparity was larger for Hispanics, males, and younger samples (age <18). In contrast, minorities were 8.6% (5.6%, 11.7%) less likely than Whites to follow-through with the full HPV vaccine series, a disparity present across all participant and study characteristics.

Conclusions and Relevance: Racial and ethnic minorities are more likely to initiate but less likely to follow through with HPV vaccination, a clear finding that self-report studies have obscured. Efforts to promote HPV vaccination should be broad, as uptake remains low across all racial and ethnic groups. Nevertheless, higher initiation among minorities offers potential for future reductions in HPV cancer disparities and may provide insights for reducing disparities in uptake of other preventive services.

Citation Format: Jennifer C. Spencer, William Calo, Noel T. Brewer. Racial and ethnic disparities and reverse disparities in HPV vaccination: A meta-analysis [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B122.