Individual- and Regional-level determinants of Human Papillomavirus (HPV) vaccine refusal: the Ontario Grade 8 HPV vaccine cohort study

BMC Public Health

Linda E Lévesque¹  Lindsey Colley¹  Beatriz E Alvarado-Llano¹  Leah M Smith²  Olivia Remes¹ 

[1] Department of Public Health Sciences, Queen’s University, 21 Arch Street, Room 313, Kingston, Ontario, Canada;Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

关键词: Cohort studies;    Vaccine hesitancy;    Vaccine coverage;    Cohort studies;    HPV vaccine;    Human papillomavirus;   

Others  :  1126335
DOI  :  10.1186/1471-2458-14-1047

 received in 2014-03-18, accepted in 2014-10-01,  发布年份 2014

【 摘 要 】

Background

Studies on the determinants of human papillomavirus (HPV) vaccine use have generally focused on individual-level characteristics, despite the potentially important influence of regional-level characteristics. Therefore, we undertook a population-based, retrospective cohort study to identify individual- and regional-level determinants of HPV vaccine refusal (non-receipt) in Ontario’s (Canada) Grade 8 HPV Immunization Program.

Methods

Ontario’s administrative health and immunization databases were used to identify girls eligible for free HPV vaccination in 2007–2011 and to ascertain individual-level characteristics of cohort members (socio-demographics, vaccination history, health care utilization, medical history). The social and material characteristics of the girl’s region (health unit) were derived from the 2006 Canadian Census. Generalized estimating equations (binomial distribution, logit link) were used to estimate the population-average effects of individual- and regional-level characteristics on HPV vaccine refusal.

Results

Our cohort consisted of 144,047 girls, 49.3% of whom refused HPV vaccination. Factors associated with refusal included a previous diagnosis of Down’s syndrome (OR = 1.37, 95% CI 1.16-1.63) or autism (OR = 1.60, 95% CI 1.34-1.90), few physician visits (OR = 1.45, 95% CI 1.35-1.55), and previous refusal of mandatory (OR = 2.23, 95% CI 2.07-2.40) and optional (OR = 3.96, 95% CI 3.87-4.05) vaccines. Refusal was highest among the lowest and highest income levels. Finally, a previous diagnosis of obesity and living in an area of high deprivation were associated with lower refusal (OR = 0.87, 95% CI 0.83-0.92 and OR = 0.82 95%, CI 0.79-0.86, respectively).

Conclusions

Studies on HPV vaccine determinants should consider regional-level factors. Efforts to increase HPV vaccine acceptance should include vulnerable populations (such as girls of low income) and girls with limited contact with the healthcare system.

【 授权许可】

   
2014 Remes et al.; licensee BioMed Central Ltd.

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