Abstract
Human papillomavirus (HPV) infection contributes to rising incidence of HPV-related oropharyngeal cancer (OPC). After the U.S. expanded HPV vaccination to adults aged 27–45 y in 2018, COVID-19 caused preventive visits and routine immunizations to plunge. We analyzed 2019 and 2022 NHIS data among adults aged 27–45 (2019 n = 8,745; 2022 n = 7,303). The primary outcome was ever HPV vaccination (≥1 dose), regardless of age at first vaccination. We estimated age-adjusted, survey-weighted coverage and used multivariable logistic regression to estimate adjusted odds of vaccination by sociodemographic characteristics; secondary 2022 analyses assessed initiation between ages 27 and 45. Ever HPV vaccine uptake increased from 15.1% in 2019 to 20.7% in 2022 (difference 5.6 percentage points; 95% CI, 4.03–7.07). In both years, lower odds were observed with increasing age, men, non-Hispanic Asian adults, individuals with lower educational attainment, and those without a usual place for care. By 2022, lower income-to-poverty ratios and lack of insurance were associated with reduced odds, whereas LGB+ and unmarried adults had higher odds, and adults in the Northeast had higher odds than those in the South. Only 1.43% (95% CI, 1.07–1.80) initiated vaccination between ages 27 and 45 in 2022. Initiation was more common among females, LGB+ and non-Hispanic Asian adults, and unmarried adults, and less common among those with lower education and no usual place for care. The increase in lifetime HPV vaccine coverage likely reflects childhood and adolescent vaccination rather than initiation at ages 27–45, which remained uncommon, and persistent inequities highlight missed opportunities for equitable OPC prevention.