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Meta-Analysis
. 2013 Jun;42(3):896-908.
doi: 10.1093/ije/dyt049. Epub 2013 Apr 25.

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

Harriet Fisher  1 , Caroline L Trotter, Suzanne Audrey, Kyle MacDonald-Wallis, Matthew Hickman
Affiliations
Meta-Analysis

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

Harriet Fisher et al. Int J Epidemiol. 2013 Jun.

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.

Keywords: HPV vaccine; ethnic disparity; immunization, adolescents; public health; socioeconomic factors.

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Figures

Figure 1
Figure 1
Flow diagram of study selection procedure
Figure 2
Figure 2
Odds ratios of HPV vaccination initiation of Black young women in comparison with White young women
Figure 3
Figure 3
Odds ratios of HPV vaccination initiation in young women belonging to lowest family or household annual income category in comparison with highest
Figure 4
Figure 4
Odds ratios of HPV vaccination initiation by lowest primary caregiver education category in comparison with highest
Figure 5
Figure 5
Odds ratios of HPV vaccination initiation by young women without healthcare insurance coverage in comparison with young women with healthcare insurance coverage
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References

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