Do parental education and income matter? A nationwide register-based study on HPV vaccine uptake in the school-based immunisation programme in Norway

Abstract

ObjectiveVaccine against human papillomavirus (HPV) has been offered free of charge to all 12-year-old girls in Norway since 2009. Nevertheless, the uptake of HPV vaccine is lower than for other childhood vaccines. The aim of this study was to examine whether parental education and income are associated with initiation and completion of HPV vaccination.DesignNationwide register-based study.SettingPublicly funded childhood immunisation programme in Norway.Participants91 405 girls born between 1997 and 1999 and registered in the Norwegian Central Population Registry were offered HPV vaccine during the first 3 programme years. Of these, 84 139 had complete information on all variables and were included in the study.MeasurementsInformation on HPV-vaccination status was obtained from the Norwegian Immunisation Registry. Data on socioeconomic factors were extracted from Statistics Norway. Risk differences (RDs) and CIs were estimated with Poisson regression.ResultsIn the study sample, 78.3% received at least one dose of HPV vaccine and 73.6% received all three doses. High maternal education was significantly associated with lower probability of initiating HPV vaccination (multivariable RD=−5.5% (95% CI −7.0% to −4.0%) for highest compared with lowest education level). In contrast, high maternal income was significantly associated with higher probability of initiating vaccination (multivariable RD=10.1% (95% CI 9.0% to 11.3%) for highest compared with lowest quintile). Paternal education and income showed similar, but weaker, associations. The negative association between education and initiation was only seen for incomes below the median value.ConclusionsIn spite of the presumably equal access to HPV vaccine in Norway, we found socioeconomic disparities in vaccine uptake. More studies are needed to explain the underlying factors responsible for the observed socioeconomic differences. Insight into these factors is necessary to target information and increase vaccination coverage to ultimately reduce HPV-related disease across socioeconomic barriers.

HPV vaccination initiation after the routine-recommended ages of 11–12 in the United States

“…Factors associated with later HPV vaccination initiation in this study appear to be fairly similar to those related to reduced HPV vaccine uptake [7] , [8] , [9] , [10] , [11] . For example, we found that having a higher maternal education and lack of healthcare utilization were associated with later initiation, and both of these factors have been previously related to reduced HPV vaccination uptake [7] , [8] , [9] , [10] , [11] . Additionally, we found that vaccine initiation occurs at older ages among HPV vaccinated females compared to Tdap and meningococcal vaccinated females.…”

“…Multiple demographic, cognitive, and contextual factors have been found to be associated with HPV vaccine uptake [7] , [8] , [9] , [10] , [11] , but much less is known about factors related to the age at vaccine initiation. The age at HPV vaccine initiation is important given that HPV infection and its related sequelae can often occur at young ages with a North American study suggesting approximately one third of unvaccinated females were HPV infected in their teen years [12] and another suggesting that cervical dysplasia and genital warts can often occur in females aged 14–17 years [13] .…”

Parents’ uptake of human papillomavirus vaccines for their children: a systematic review and meta-analysis of observational studies

“…The 79 included studies 22–100 were all published in English. The majority (69.6%; n=55) were conducted in the USA, 23 27 34 38–41 45 46 48–54 56–62 64 65 67–69 71–77 80–94 97–99 with four conducted in Canada (5.1%), 24 28 36 37 four in the Netherlands (5.1%), 26 33 35 55 two in Denmark, 22 29 two in Norway, 30 31 two in Puerto Rico, 63 70 and one each in Austria, 43 Fiji, 44 Hong Kong, 96 Italy, 47 Kenya, 66 South Africa, 42 Tanzania, 32 Turkey, 100 United Arab Emirates 95 and Vietnam. 25 …”

Factors affecting HPV vaccine acceptance in west Austria: Do we need to revise the current immunization scheme?

“…Majority of these reports indicated a paradoxical outcome of higher parental education having negative effect on HPV vaccination [13] , [14] , [15] , [16] . A large register-based study in Norway based on about 85 000 study participants noted such an association both for maternal and paternal educational status, the degree of association being higher for that of maternal education [20] . These findings of inverse association are explained mainly by the fact that educated parents tend to undertake own internet research making them likely to end up in websites with unclear and confusing information on HPV or even websites which clearly condemn the vaccine [21] , [22] , [23] .…”