Determinants associated with lower HPV vaccination uptake in the school-based program for girls - A follow-up of the...

Human papillomavirus (HPV) vaccinations were introduced in the Swedish National Immunization Program (NIP) for girls in 2012. This study aims to examine socioeconomic factors among schoolgirls and their parents associated with low HPV vaccine uptake (first dose) according to the NIP schedule (aged 11-13 years) and to identify determinants of not receiving catch-up vaccinations and remaining unvaccinated up to age 19 years.

This nationwide, retrospective, registry-based cohort study included all girls born in 2002-2010 residing in Sweden at age 11-13 years. The final analysis included 492,997 girls and their respective parents. The importance of country of birth, educational level, and family income for not being vaccinated was assessed by univariate and multivariable logistic regression. An analysis of catch-up vaccinations included 65,377 unvaccinated girls born in 2002-2009.

Girls having parents with low educational level (OR 1.3 [95%CI: 1.3-1.4]) or having parents with low family income (OR 1.9 [95%CI: 1.9-2.0]) were more likely to be unvaccinated according to schedule compared to girls with parents having high educational level or income. Girls born abroad (OR 1.7 [95%CI: 1.6-1.8]), having one parent born abroad and one born in Sweden, as well as girls born in Sweden having parents born abroad (OR 1.7 [95%CI: 1.7-1.8]), were more likely to be unvaccinated compared to girls and parents born in Sweden. Determinants for not receiving a catch-up vaccination during the observational period were similar to those of the unvaccinated girls according to the schedule but varied by year of observation.

Socioeconomic inequalities persist in receiving the first dose of HPV vaccine according to the Swedish NIP schedule, despite being included in the NIP since 2012. The majority of those not vaccinated according to the schedule did not receive catch-up vaccinations. Catch-up vaccination needs to be tailored and strengthened.