Abstract
BackgroundIn France, there are recommendations and reimbursements for human papillomavirus (HPV) vaccination but no HPV vaccination programs. Therefore, vaccination is largely determined by parents’ initiative, which can lead to inequalities. The objective of this study was to determine the factors associated with poorer vaccination coverage rates in the most populated region of France.MethodsThe data of this study were obtained from the National Health Insurance between 2011 and 2013. Correlations between vaccination initiation rate (at least 1 dose reimbursed) and socio-demographic/cultural factors were assessed using Pearson’s product-moment correlation coefficient. Multivariate analyses were performed using logistic regression.ResultsIn total, 121,636 girls received at least one HPV vaccine dose. The vaccination rate for girls born from 1996 to 1999 was 18.7%. Disparities in vaccination coverage rates were observed between the 8 departments of the region, ranging from 12.9% to 22.6%. At the department level, unemployment, proportion of immigrants and foreigners, and coverage by CMU health insurance (“Couverture Maladie Universelle”, a health insurance plan for those who are not otherwise covered through business or employment and who have a low income) were significantly inversely correlated with vaccination rates, whereas urban residence, medical density, income and use of medical services were not related to coverage. In the multivariate model, only the percentage of foreigners remained independently associated with lower vaccination coverage. At the individual level, the use of medical services was a strong driver of HPV vaccination initiation.ConclusionWe observed geographic disparities in HPV vaccination initiation coverage. Even if no clear factor was identified as a vaccination determinant, we observed a failure of vaccination only based on parents’ initiative. Therefore, an organized policy on HPV vaccination, such as school-based programs, can help improve coverage rates.
Highlights
Clinical trials have shown that prophylactic vaccination against human papillomavirus (HPV) prevents infection with HPV types 16 and 18 [1,2,3] as well as high-grade cervical intraepithelial lesions, which are precursors of cervical cancers [4,5]
Disparities in vaccination coverage rates were observed between the 8 departments of the region, ranging from 12.9% to 22.6%
Unemployment, proportion of immigrants and foreigners, and coverage by CMU health insurance (“Couverture Maladie Universelle”, a health insurance plan for those who are not otherwise covered through business or employment and who have a low income) were significantly inversely correlated with vaccination rates, whereas urban residence, medical density, income and use of medical services were not related to coverage
Summary
Clinical trials have shown that prophylactic vaccination against human papillomavirus (HPV) prevents infection with HPV types 16 and 18 [1,2,3] as well as high-grade cervical intraepithelial lesions, which are precursors of cervical cancers [4,5]. In 2013, only 38% of girls aged 18 years old had completed the vaccination protocol, and only 18% of girls aged 15 years old had received at least one dose of the vaccine [6] These rates are lower than those observed in other countries, such as in Australia, which has a coverage of 70% of the target population, and Great Britain, which has an 80% vaccination rate [3, 4]. The objective of this study was to determine the socio-demographic and/or geographic factors associated with poorer vaccination coverage rates in a large French population.
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