Social equity in Human Papillomavirus vaccination: a natural experiment in Calgary Canada

BMC Public Health

Deborah A McNeil⁴  M Sarah Rose¹  Judy Seidel²  J Cyne Johnston²  Jodi E Siever³  Richard Musto² 

[1] Rho - Sigma Scientific Consultants, Calgary, AB, Canada;Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;Population and Public Health, Alberta Health Services, Calgary, AB, Canada;Faculty of Nursing, University of Calgary, Calgary, AB, Canada

关键词: Deprivation;    Childhood immunization;    Health equity;    Human Papillomavirus vaccines;    Public Health;   

Others  :  1162042
DOI  :  10.1186/1471-2458-13-640

 received in 2013-03-06, accepted in 2013-07-05,  发布年份 2013

【 摘 要 】

Background

The Alberta Immunization Program offers a vaccine against the Human Papillomavirus (HPV) free of charge to all girls in Grades 5 and 9. The vaccine is provided in two different service delivery models depending upon the acceptance of the program by the local school board. Vaccinations may be provided “in-school” or in “community” through appointments at Public Health Clinics. The purpose of this study was to determine whether there was a difference in vaccine uptake in Calgary between the two service delivery models, “in-school” and “community”, and to examine if socioeconomic status (SES) was a contributing factor.

Methods

Individual data from the Calgary Zone Public Health vaccination database for all grade 5 and 9 girls in Calgary for school years 2008–2011 were analyzed using descriptive statistics. These data included vaccination records for 35,592 girls. Logistic regression was used to examine the effect of delivery system and SES status on being vaccinated, controlling for school type.

Results

HPV vaccination completion rates were 75% (95% confidence interval = 74.7%, 75.8%) for girls with an “in-school” compared to 36% (95% confidence interval = 35.3%, 37.2%) for girls in schools with a “community” service delivery model. A girl’s neighbourhood SES was related to the likelihood of being HPV vaccinated depending on the service delivery model available to her. For girls attending a Public school with an “in-school” delivery model, the proportion completing vaccination increased as SES decreased (high SES = 79%; medium SES = 79%; low SES = 83%; p-value<0.001). For girls attending Calgary Catholic School District schools with the “community” delivery model there was a decrease in immunization rates from high and mid to low SES (high SES = 41%; medium SES = 42%; low SES = 34%; p-value<0.001). These results show that those with lower SES were differentially disadvantaged by not having access to an “in-school” vaccination delivery model.

Conclusion

Service delivery models make a difference in HPV vaccination completion rates and create inequities for health protection and disease prevention based on socioeconomic status.

【 授权许可】

   
2013 Musto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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