Inequalities in the uptake of Human Papillomavirus Vaccination: a systematic review and meta-analysis

Abstract

Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level.Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity.Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation.Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.

Inequalities in vaccination coverage for young females whose parents are informal caregivers

“…We used Poisson regression with robust variance to estimate overall and subgroup-specific (i.e., by age group, racial/ethnic group, and insurance subgroup given evidence of potential differences in vaccine uptake by these factors) 11,12 HPV and influenza vaccination prevalence ratios (PR) and corresponding 95% confidence limits (CL) 13 comparing females whose parents were informal caregivers with females whose parents were not informal caregivers. We identified a minimal sufficient set of covariates for adjustment to reduce confounding bias using the back-door criterion in a directed acyclic graph.…”

Compliance with Age at Initiation of Human Papillomavirus Vaccine Series by Socioeconomic Status, Race/Ethnicity, and Health Insurance Coverage Among 13-17 Year-Old Females Who Received at Least One HPV Vaccine Shot: United States, 2011

“…Incorporating more recent published articles, Fisher's updated review strengthened some of Kessels' findings on disparities in HPV vaccine initiation experienced by racial/ethnic minorities and people without health insurance coverage (21).…”

“…In 2013, Fisher supported some of Kessels' findings with a more comprehensive systematic review and meta-analysis of the literature regarding racial/ethnic and SES differences in HPV vaccine uptake (21). Incorporating more recent published articles, Fisher's updated review strengthened some of Kessels' findings on disparities in HPV vaccine initiation experienced by racial/ethnic minorities and people without health insurance coverage (21).…”

“…This decrease is thought to be due to the success of public health preventions and wide-scale implementation of Pap smear screenings (15). Despite this reduction, non-Hispanic Blacks and Hispanics are less likely than non-Hispanic Whites to initiate the HPV vaccination series (18,19,20,21).…”

Geospatial Patterns in Human Papillomavirus Vaccination Uptake: Evidence from Uninsured and Publicly Insured Children in North Carolina

“…Vaccination is of particular importance for under-and uninsured children, who are less likely to be vaccinated (11,12) and therefore more likely to become infected (13). Several barriers to HPV vaccination exist, including low levels of provider recommendation (14), parental concerns about the vaccine's effect on sexual behavior and perceptions of risk (14), religious affiliation (14), and low access to the health care system (15).…”