Spencer Angela M, Roberts Stephen A, Brabin Loretta, Patnick Julietta, Verma Arpana
Manchester Urban Collaboration on Health, Institute of Population Health, Manchester Academic Health Sciences Centre, University of Manchester, , Manchester, UK.
J Epidemiol Community Health. 2014 Jun;68(6):571-7. doi: 10.1136/jech-2013-202629. Epub 2014 Feb 24.
Achieving high human papillomavirus (HPV) vaccine coverage may reduce inequalities in cervical cancer prevention by mitigating the inequalities seen in the cervical screening programme. This paper assesses whether the same sociodemographic factors are associated with both cervical screening and HPV vaccination.
Girls' HPV vaccination records were linked by address to cervical screening records for their mothers in the North West of England. Index of Multiple Deprivation scores (2010) and census ethnicity data (2001) were used to investigate the association between deprivation and ethnic composition of area of residence with HPV vaccination and cervical screening uptake, along with potential differences between Primary Care Trusts (PCTs), which were responsible for vaccine delivery.
Deprivation was not associated with routine (12-13-year-olds) vaccination initiation, but girls living in the most deprived quintile were significantly less likely to complete the three vaccine doses (OR 0.75; 95% CI 0.63 to 0.88). Mother-daughter pairs failing to engage in either screening or vaccination were also more likely to live in deprived areas (routine vaccination OR for most deprived quintile: 2.35; 95% CI 2.00 to 2.77). There were differences between PCTs after controlling for demographic effects (OR 1.35; 95% CI 1.23 to 1.52).
Ensuring completion of the vaccine schedule is critical for organisations responsible for vaccine delivery in order to reduce cancer risk among girls living in deprived areas. There remains a small minority of mothers and daughters from disadvantaged backgrounds who do not participate in either cervical screening or HPV vaccination.
通过缓解宫颈癌筛查项目中存在的不平等现象，实现高人类乳头瘤病毒（HPV）疫苗接种覆盖率可能会减少宫颈癌预防方面的不平等。本文评估相同的社会人口学因素是否与宫颈癌筛查和HPV疫苗接种均相关。
在英格兰西北部，根据地址将女孩的HPV疫苗接种记录与其母亲的宫颈癌筛查记录相联系。使用多重剥夺指数得分（2010年）和人口普查种族数据（2001年）来调查居住地区的剥夺和种族构成与HPV疫苗接种及宫颈癌筛查接受率之间的关联，以及负责疫苗接种的初级保健信托基金（PCT）之间的潜在差异。
剥夺与常规（12至13岁）疫苗接种起始无关，但生活在最贫困五分之一地区的女孩完成三剂疫苗接种的可能性显著降低（比值比0.75；95%置信区间0.63至0.88）。未参与筛查或疫苗接种的母女组合也更有可能居住在贫困地区（最贫困五分之一地区的常规疫苗接种比值比：2.35；95%置信区间2.00至2.77）。在控制人口统计学效应后，PCT之间存在差异（比值比1.35；95%置信区间1.23至1.52）。
对于负责疫苗接种的组织来说，确保完成疫苗接种计划对于降低贫困地区女孩的癌症风险至关重要。仍有一小部分来自弱势背景的母女既不参与宫颈癌筛查也不参与HPV疫苗接种。
