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Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis.

Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M - Int J Epidemiol (2013)

Bottom Line: 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.In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40-0.78).The majority of studies originated from the USA.

View Article: PubMed Central - PubMed

Affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. Harriet.Fisher@bristol.ac.uk

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.

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Odds ratios of HPV vaccination initiation of Black young women in comparison with White young women
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dyt049-F2: Odds ratios of HPV vaccination initiation of Black young women in comparison with White young women

Mentions: Overall, 14 studies9–22 reported data facilitating comparison of HPV vaccination initiation by ethnicity. There was strong evidence of heterogeneity for analyses comparing Latina and Asian young women with White young women and these estimates were not pooled (P < 0.001, I2 = 93.5% and P < 0.01, I2 = 78.4%, respectively). Pooled estimates indicate that on average Black young women were less likely to initiate HPV vaccination than White young women (combined OR: 0.89, 95% CI: 0.82–0.97, P < 0.01, I2 = 63.5%) (Figure 2).Figure 2


Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis.

Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M - Int J Epidemiol (2013)

Odds ratios of HPV vaccination initiation of Black young women in comparison with White young women
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3733698&req=5

dyt049-F2: Odds ratios of HPV vaccination initiation of Black young women in comparison with White young women
Mentions: Overall, 14 studies9–22 reported data facilitating comparison of HPV vaccination initiation by ethnicity. There was strong evidence of heterogeneity for analyses comparing Latina and Asian young women with White young women and these estimates were not pooled (P < 0.001, I2 = 93.5% and P < 0.01, I2 = 78.4%, respectively). Pooled estimates indicate that on average Black young women were less likely to initiate HPV vaccination than White young women (combined OR: 0.89, 95% CI: 0.82–0.97, P < 0.01, I2 = 63.5%) (Figure 2).Figure 2

Bottom Line: 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.In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40-0.78).The majority of studies originated from the USA.

View Article: PubMed Central - PubMed

Affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK. Harriet.Fisher@bristol.ac.uk

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.

Show MeSH
Related in: MedlinePlus