Uptake of HPV vaccination and associated factors in France: a nationwide study from 2007 to 2023

Although HPV vaccination coverage has remained low in France, information on barriers to vaccination is incomplete. This nationwide study aimed to assess HPV vaccination uptake and associated factors alongside the evolving recommendations since its implementation.

Using data from the French National Health Data System (SNDS), all individuals aged 10-29 years were included. Annual HPV vaccination uptake between 2007 and 2023 was assessed by age group and sex. Associations between individuals' socio-demographic, healthcare use and access and medical characteristics with HPV vaccination were assessed using multivariable logistic regression models.

Among 27.9 million (M) individuals included, 5.9M received HPV vaccination: 3.4M (2.7M females/0.7M males) aged 10-14, 2.2M (1.9M/0.3M) aged 15-19, and 0.28M (240,000/40,000) aged 20-29. Annual vaccination uptake consistently increased since 2012, reaching up to 17.1% and 15.7% of 10-14-year-old females and males in 2023. Across all age and sex groups, socioeconomic disadvantage was associated with lower odds of vaccination (adjusted odds ratios ranging from 0.45 to 0.84 for complementary health insurance allowance beneficiaries, and from 0.55 to 0.73 for those living in the most deprived quintile of municipalities), and these disparities widened over time among females aged 10-19. While probability of HPV vaccination increased with the number of contacts with the primary healthcare system, Down syndrome, diabetes and mental health disorders were associated with decreased odds of HPV vaccination.

Until 2023, disadvantaged young people, those with limited access to healthcare or suffering from chronic illnesses, benefited less from HPV vaccination than those more privileged.